LYZA TENNILLE GAINES CRNP NPI 1518912369

NPI Information

NPI: 1518912369
Provider Name: LYZA TENNILLE GAINES, CRNP
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Individual

Specialization: Pediatrics

PECOS Registration: Yes

Address:
415 MEDICAL CENTER DR SW
FORT PAYNE, AL
ZIP 35968
Phone: (256) 997-2820
Get Directions

Lyza Tennille Gaines, CRNP is a pediatrics nurse practitioner in Fort Payne, AL. Lyza Tennille Gaines, CRNP NPI is 1518912369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

415 MEDICAL CENTER DR SW
FORT PAYNE, AL
ZIP 35968-421
Phone: (256) 997-2820
Fax: (256) 997-2890

The NPI 1518912369 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/23/2006 and was last updated on 9/26/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	1-091459	ALABAMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	051533716	MEDICAID	ALABAMA
2	515-33716	OTHER	ALABAMA	BCBS
3	051533716GAI	MEDICARE PIN	ALABAMA
4	P93682	MEDICARE UPIN	ALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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