Provider Demographics
NPI:1003238353
Name:LYNN, MISTI (NP-C)
Entity Type:Individual
Prefix:MS
First Name:MISTI
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N ROADRUNNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7043
Mailing Address - Country:US
Mailing Address - Phone:575-300-5277
Mailing Address - Fax:855-848-7296
Practice Address - Street 1:115 N ROADRUNNER PKWY STE 1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7043
Practice Address - Country:US
Practice Address - Phone:575-300-5277
Practice Address - Fax:855-848-7296
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000018106363LF0000X
NMCNP-02392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM345387YUD3Medicare UPIN