Raven Danielle Lyles
Nurse Anesthetist, Certified Registered in Charlotte, NC. Individual provider (NPI-1).
NPI number1013661230
StatusActive
Last updated in NPPESMar 27, 2026
Details
- NPI
- 1013661230
- Entity type
- Individual (NPI-1)
- Name
- Raven Danielle Lyles
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 7, 2022
- Certification date
- Mar 27, 2026
- Last updated
- Mar 27, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 0024186691 | VA | Yes |
| 163W00000X | Registered Nurse | 904663 | MS | |
| 367500000X | Nurse Anesthetist, Certified Registered | 6828 | NC |
Practice location
200 Hawthorne LnCharlotte, NC 28204-2515
Phone 704-384-4274
Mailing address
355 Old Spanish TrlJackson, MS 39212-3210
Phone 601-405-1782
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