Provider Demographics
NPI:1184846172
Name:DECHRISTOPHER, LYNETTE (PAC)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:DECHRISTOPHER
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:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1615
Mailing Address - Country:US
Mailing Address - Phone:304-599-8802
Mailing Address - Fax:304-599-5607
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1134
Practice Address - Country:US
Practice Address - Phone:304-599-8802
Practice Address - Fax:304-599-5607
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant