Provider Demographics
NPI:1992956742
Name:LYONS-FARINO, JESSICA KATHERINE (RPA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHERINE
Last Name:LYONS-FARINO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:10775 PIONEER TRL STE 215
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0234
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111684363A00000X
TXPA05993363A00000X
COPA0005661363A00000X
ALPA1420363A00000X
AZ7351363A00000X
CA55971363A00000X
NY012732-1363A00000X
FLPA 9104865363A00000X
NVPA2118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L10408OtherMEDICARE PIN
TX8L10409OtherMEDICARE PIN
TX8L10407OtherMEDICARE PIN
TX8L10405OtherMEIDCARE PIN
TX8L10406OtherMEDICARE PIN