Provider Demographics
NPI:1164026076
Name:LEMASTERS, TYVETTE
Entity Type:Individual
Prefix:
First Name:TYVETTE
Middle Name:
Last Name:LEMASTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1219
Mailing Address - Country:US
Mailing Address - Phone:304-337-9230
Mailing Address - Fax:304-337-9236
Practice Address - Street 1:2579 UPPER RUN RD
Practice Address - Street 2:
Practice Address - City:JACKSONBURG
Practice Address - State:WV
Practice Address - Zip Code:26377-9014
Practice Address - Country:US
Practice Address - Phone:304-815-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16998963163747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1699896316Medicaid