MEDICARE: LYNETTE J CLINE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	01177	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093714099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE J CLINE PAC

Provider Business Mailing Address
First Line	:	1300 FORT PIERPONT DR STE 101
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1314
Country	:	US
Telephone Number	:	304-241-7150
Fax Number	:	304-599-8917

Provider Business Practice Location Address
First Line	:	1300 FORT PIERPONT DR STE 101
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508
Country	:	US
Telephone Number	:	304-241-7150
Fax Number	:	304-599-8917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	06/17/2021

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Directions to “ LYNETTE J CLINE PAC” Practice Location

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