Provider Demographics
NPI:1720754542
Name:LYTLE, LISA ANN (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LYTLE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 HILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1677
Mailing Address - Country:US
Mailing Address - Phone:304-206-1635
Mailing Address - Fax:
Practice Address - Street 1:5416 HILLBROOK DR
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1677
Practice Address - Country:US
Practice Address - Phone:304-206-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily