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General NPI Number Information
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NPI Number | 1295065688
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Entity Type | Individual
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Provider Name | LISA ANN WYNN APRN
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 41718 W MORGAN AVE STE 101
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-3224
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Country | US
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Telephone | 276-231-9228
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Fax | 877-770-7177
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Provider Business Mailing Address
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Address Line | 334 CORINTH CHURCH DR
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City | JONESVILLE
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State | VA
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Zip | 24263-7992
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Country | US
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Telephone | 606-795-7533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3010956
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024184082
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024184082
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License Number State | VA
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