Healthcare Provider Details

I. General information

NPI: 1659901817
Provider Name (Legal Business Name): LYNDSAY MEGAN WICKLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 WASHINGTON ST
RAVENSWOOD WV
26164-1729
US

IV. Provider business mailing address

705 WASHINGTON ST
RAVENSWOOD WV
26164-1729
US

V. Phone/Fax

Practice location:
  • Phone: 304-868-6000
  • Fax: 304-868-6002
Mailing address:
  • Phone: 304-868-6000
  • Fax: 304-868-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number105139
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78677
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: