Provider Demographics
NPI:1669653663
Name:WOMBLE, LYNETTE A (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:A
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:WOMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:704 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3424
Mailing Address - Country:US
Mailing Address - Phone:931-685-9277
Mailing Address - Fax:931-685-9244
Practice Address - Street 1:704 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3424
Practice Address - Country:US
Practice Address - Phone:931-685-9277
Practice Address - Fax:931-685-9244
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily