Gaines, Lyza Tennille

Gaines, Lyza Tennille is an individual health care provider with primary practice located at 415 Medical Center Dr Sw , Fort Payne AL 35968-3421. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Gaines, Lyza Tennille can be contacted via phone (256) 997-2820.

Contact Information

Primary practice address
415 Medical Center Dr Sw Fort Payne AL 35968-3421
Phone: (256) 997-2820
Fax: (256) 997-2890
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 1-091459 Alabama

Profile Details

NPI number 1518912369
LBN Legal business name Gaines, Lyza Tennille
Credentials CRNP
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2006
Last updated Sep 26th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518912369 NPPES
Alabama MEDICAID 051533716
Alabama Other 515-33716

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