Provider Demographics
NPI:1578193561
Name:LYLE, ELYSHA DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:ELYSHA
Middle Name:DAWN
Last Name:LYLE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-381-4664
Practice Address - Fax:901-373-0804
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2024-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4293363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical