Basic Information
| Provider Information | |||||||||
| NPI: | 1679130124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYSSY | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | AMANDA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 S LAMAR BLVD APT 2317 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787042656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106323931 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W BEN WHITE BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | T7293 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 5151013543 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.