Provider Demographics
NPI:1518900604
Name:LYNCH, NANCY S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:S
Last Name:LYNCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-253-6060
Mailing Address - Fax:304-929-2248
Practice Address - Street 1:275 DRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-253-6060
Practice Address - Fax:304-929-2248
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV038800122363L00000X
WV25477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006646Medicaid
WV3810006646Medicaid
Q49380Medicare UPIN