Individual
MR. JOHN WAYNE LILLY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, FNP-BC
Contact information
Practice address
330 N. EISENHOWER DR., BECKLEY, WV 25801-3140
(304) 929-0786
(304) 929-2278
Mailing address
330 N EISENHOWER DR, BECKLEY, WV 25801-4141
(304) 929-0786
(304) 929-2278
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
64742
WV
Other
Enumeration date
01/03/2012
Last updated
06/13/2014
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