Provider Demographics
NPI:1013209188
Name:MARTIN, MARY LYNN (RN, ANP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, ANP-C
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Other - First Name:
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Mailing Address - Street 1:11020 KING ST STE 220
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1201
Mailing Address - Country:US
Mailing Address - Phone:913-730-7746
Mailing Address - Fax:913-214-2221
Practice Address - Street 1:11020 KING ST STE 220
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1201
Practice Address - Country:US
Practice Address - Phone:913-730-7746
Practice Address - Fax:913-214-2221
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011009484363LA2200X, 363L00000X
KS5375392021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner