Provider Demographics
NPI:1538543954
Name:LYONS, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-0817
Mailing Address - Country:US
Mailing Address - Phone:405-743-1968
Mailing Address - Fax:405-743-1595
Practice Address - Street 1:608 W HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-1530
Practice Address - Country:US
Practice Address - Phone:405-743-1968
Practice Address - Fax:405-743-1595
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator