MEDICARE: MR. PERCY LEE LYNCHARD III ARNP

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	363LF0000X	Family Nurse Practitioner	AP60800360	WA
2	363L00000X	Nurse Practitioner	AP60800360	WA

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
2	395774	OTHER	WA	L&I

General Provider Information

NPI Number	:	1881108553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PERCY LEE LYNCHARD III ARNP

Provider Business Mailing Address
First Line	:	1320 MERKEL ST NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98516-5424
Country	:	US
Telephone Number	:	360-918-6856
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 HARRISON AVE NW STE 101
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5084
Country	:	US
Telephone Number	:	360-704-2362
Fax Number	:	360-350-1445

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

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	03/26/2021

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