Provider Demographics
NPI:1003889825
Name:LYBROOK, ALLEN R (APRN,BC)
Entity Type:Individual
Prefix:MS
First Name:ALLEN
Middle Name:R
Last Name:LYBROOK
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6605
Mailing Address - Country:US
Mailing Address - Phone:229-226-5788
Mailing Address - Fax:229-226-2548
Practice Address - Street 1:116 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6605
Practice Address - Country:US
Practice Address - Phone:229-226-5788
Practice Address - Fax:229-226-2548
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN071414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00804152BMedicaid
GA50BBJGTMedicare ID - Type UnspecifiedGEORGIA MEDICARE PART B
GAP00213721Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA00804152BMedicaid