Healthcare Provider Details

I. General information

NPI: 1881108553
Provider Name (Legal Business Name): PERCY LEE LYNCHARD III ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 HARRISON AVE NW STE 101
OLYMPIA WA
98502-5084
US

IV. Provider business mailing address

1320 MERKEL ST NE
OLYMPIA WA
98516-5424
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-2362
  • Fax: 360-350-1445
Mailing address:
  • Phone: 360-918-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60800360
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60800360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: