Individual
LYZA TENNILLE GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
415 MEDICAL CENTER DR SW, FORT PAYNE, AL 35968-3421
(256) 997-2820
(256) 997-2890
Mailing address
415 MEDICAL CENTER DR SW, FORT PAYNE, AL 35968-3421
(256) 997-2820
(256) 997-2890
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1-091459
AL
363LP0200X
Pediatric Nurse Practitioner
Primary
1-091459
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051533716
—
AL
01
—
515-33716
BCBS
AL
Enumeration date
05/23/2006
Last updated
08/21/2025
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