Provider Demographics
NPI:1952032393
Name:BYNO, LACUTLASS SHARNISE (NP)
Entity Type:Individual
Prefix:
First Name:LACUTLASS
Middle Name:SHARNISE
Last Name:BYNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13243 WILLOW NEST DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5030
Mailing Address - Country:US
Mailing Address - Phone:662-806-8275
Mailing Address - Fax:
Practice Address - Street 1:240 NEW BYHALIA RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3716
Practice Address - Country:US
Practice Address - Phone:901-492-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily