Provider Demographics
NPI:1386236685
Name:BYRD, LOTTIE L
Entity type:Individual
Prefix:
First Name:LOTTIE
Middle Name:L
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 LIVERPOOL RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:WV
Mailing Address - Zip Code:25252-7017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3331 LIVERPOOL RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:WV
Practice Address - Zip Code:25252-7017
Practice Address - Country:US
Practice Address - Phone:304-786-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker