Dwight H Lysne, MD, MDIV

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

200301378 Issued in NC

Practice address

20 S 16TH St
Wilmington, NC 28401-4924

Phone

(877) 456-6729

Fax

(910) 399-3928

NPI assigned

Apr 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Haven Ministries, Inc.

  • Psychiatry Physician
  • Wilmington, NC
  • NPI 1649720889
  NPD (past) Authorized official
• Center for Psychiatric Care

  • Psychiatry Physician
  • Grand Forks, ND
  • NPI 1043271885
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348617600000",
    "number": "1083679062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7212 OYSTER LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284117132",
            "telephone_number": "910-465-1935",
            "fax_number": "910-399-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284014924",
            "telephone_number": "877-456-6729",
            "fax_number": "910-399-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSNE",
        "first_name": "DWIGHT",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD, MDIV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2012-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ND",
            "license": "5512",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MN",
            "license": "28290",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "200301378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBC/BS",
            "identifier": "94D78LY",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15992",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "937078100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBCBS",
            "identifier": "19977",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260045000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891378J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison B Lynn, MD
• Charles Franklin Lyon, CADC
• Jamie Lyons, PA
• Victoria Janine Lyons, NP
• Dawn Lysne, MD
• Kayleen Maag
• Amber Lynn Maberry
• Gretchen Mabry
• Desiree Macdonald
• Gigi Milou Macdonald, MD

• All providers in Wilmington, NC
• Child & Adolescent Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.