LYZA TENNILLE GAINES (NPI# 1518912369) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518912369 |
| Entity Type | Individual |
| Full Name | LYZA TENNILLE GAINES |
| Credential | CRNP |
| Practice Address |
415 Medical Center Dr Sw Fort Payne AL 35968-3421 |
| Practice Telephone | 2569972820 |
| Practice Fax Number | 2569972890 |
| Mailing Telephone | 2569972820 |
| Mailing Fax Number | 2569972890 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2012-09-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
1-091459 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | BCBS | 515-33716 | 01 |
| AL | 051533716 | 05 |
| Street Address |
415 MEDICAL CENTER DR SW |
| City | FORT PAYNE |
| State | AL |
| Zip Code | 35968-3421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073568812 | Daniel Martin Mince | Internal Medicine | 415 Medical Center Dr Sw, Fort Payne, AL 35968-3421 | 2006-05-23 |
| 1578185393 | Provision Health Services, LLC | Nurse Practitioner | 415 Medical Center Dr Sw, Fort Payne, AL 35968-3421 | 2020-05-14 |
| 1144433905 | Thomas Dalsgaard Nielsen | Internal Medicine | 415 Medical Center Dr Sw, Fort Payne, AL 35968-3421 | 2007-05-08 |
| 1184679938 | Fort Payne Rhc Corp | Clinic/Center | 415 Medical Center Dr Sw, Fort Payne, AL 35968-3421 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417382623 | Lori Land Camp | Pharmacist | 101 Cracker Barrel Row, Ft Payne, AL 35968 | 2013-09-06 |
| 1841424959 | Ashley Renee Cole | Emergency Medicine | 590 Medical Center Dr, Fort Payne, AL 35968 | 2009-05-05 |
| 1871758938 | Michael Steven Digby | Dermatology | 1403 Old Water Works Rd Sw, Fort Payne, AL 35968 | 2008-07-28 |
| 1356516611 | Robyn Reesman, O.d.,inc. | Optometrist | 2001 Glenn Blvd. Sw, Fort Payne, AL 35968 | 2008-04-28 |
| 1124219902 | Rebecca Burns Ingram | Occupational Therapist | 2804 Greenhill Blvd Nw Ste 102, Fort Payne, AL 35968 | 2007-08-06 |
| 1467657957 | Palmer Orthopaedic & Sports Medicine, PC | Orthopaedic Surgery | 315 Medical Center Dr. Sw, Fort Payne, AL 35968 | 2007-06-15 |
| 1225171309 | Dekalb County Health Dept Offsite Epsdt | Public Health or Welfare | 2401 Calvin Dr, S.w., Ft. Payne, AL 35968 | 2007-02-15 |
| 1376612648 | American Hospice -- Fort Payne | Hospice Care, Community Based | 103 3rd Street North West, Suite 202, Fort Payne, AL 35968 | 2006-11-08 |
| 1316978588 | Bhc-palmer Orthopaedics and Sports Medicine | Specialist | 315 Medical Park, Fort Payne, AL 35968 | 2006-07-06 |
| 1487694782 | Fort Payne Hospital Corporation | Hospitalist | 200 Medical Center Dr., Fort Payne, AL 35968 | 2006-06-07 |
| Find all providers in zip 35968 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507104 | Kaylee Ragan Kwan | Nurse Practitioner | 1359 Old Water Works Rd Sw, Fort Payne, AL 35968-3347 | 2020-10-28 |
| 1073013884 | Jennifer Frances Hand | Nurse Practitioner | 1359 Old Water Works Rd Sw, Fort Payne, AL 35968-3347 | 2018-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225636038 | Samantha Thompson | Nurse Practitioner | 1600 7th Ave S Fl 2, Birmingham, AL 35233-1711 | 2020-10-14 |
| 1831722289 | Tiffany Garrett | Nurse Practitioner | 333 Whitesport Dr Sw Ste 104, Huntsville, AL 35801-3455 | 2020-02-13 |
| 1033776612 | Erin Tracy Swing | Nurse Practitioner | 1600 7th Ave S Fl Apass2, Birmingham, AL 35233-1711 | 2019-05-20 |
| 1629531181 | Holley Lewis Collins | Nurse Practitioner | 1601 Center St Ste 1a, Mobile, AL 36604-1541 | 2019-04-11 |
| 1023591245 | Katherine Leigh Cassidy | Nurse Practitioner | 2001 Fieldstown Rd, Gardendale, AL 35071-4628 | 2018-09-13 |
| 1588145544 | Allison Mcdill Williams | Nurse Practitioner | 1101 Stephen J White Memorial Boulevard, Talladega, AL 35160 | 2018-08-27 |
| 1740769801 | Amy Leigh Jenkins | Nurse Practitioner | 1600 7th Ave S Bldg Suit5604, Birmingham, AL 35233-1711 | 2018-08-09 |
| 1467931949 | Kelly M Bonnett | Nurse Practitioner | 117 N Chalkville Rd, Trussville, AL 35173 | 2018-08-07 |
| 1184102931 | Molly Dixon Bolton | Nurse Practitioner | 1600 7th Ave S Bldg Suite620, Birmingham, AL 35233-1711 | 2018-08-03 |
| 1760968580 | Gladys Cooks | Nurse Practitioner | 8517 Highlands Trce, Trussville, AL 35173-3815 | 2018-07-15 |
| Find all providers with the same taxonomy | ||||
| City | FORT PAYNE |
| Zip Code | 35968 |
Please comment or provide details below to improve the information on LYZA TENNILLE GAINES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.