Provider Demographics
NPI:1609898576
Name:WYCHE, DONNA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LEE
Last Name:WYCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:WYCHE-BASHOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:SUITE #1
Mailing Address - Street 2:308 SUNSET DRIVE
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-282-2822
Mailing Address - Fax:423-282-5492
Practice Address - Street 1:308 SUNSET DR STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2489
Practice Address - Country:US
Practice Address - Phone:423-282-2822
Practice Address - Fax:423-283-5440
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020021207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3056258Medicaid
F03121Medicare UPIN
TN3056258Medicaid