Provider Demographics
NPI:1093714099
Name:CLINE, LYNETTE J (PAC)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:J
Last Name:CLINE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FORT PIERPONT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1314
Mailing Address - Country:US
Mailing Address - Phone:304-241-7150
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:1300 FORT PIERPONT DR STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-241-7150
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004490Medicaid
NC2763044Medicare ID - Type UnspecifiedJULIAN T PIERCE HLTH CTR
WV3810004490Medicaid
CL2027331Medicare PIN
Q14785Medicare UPIN
NC2763044CMedicare ID - Type UnspecifiedLUMBERTON HEALTH CENTER
NC2763044BMedicare ID - Type UnspecifiedSOUTH ROBESON MEDICAL CTR
CL2027334Medicare PIN