Healthcare Provider Details

I. General information

NPI: 1609898576
Provider Name (Legal Business Name): DONNA LEE WYCHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA LEE WYCHE-BASHOR MD

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SUNSET DR STE 1
JOHNSON CITY TN
37604-2489
US

IV. Provider business mailing address

SUITE #1 308 SUNSET DRIVE
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-2822
  • Fax: 423-283-5440
Mailing address:
  • Phone: 423-282-2822
  • Fax: 423-282-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD0000020021
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: