Provider Demographics
NPI:1023024940
Name:CLARK, LYNN A (ARNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5300
Mailing Address - Country:US
Mailing Address - Phone:253-382-8150
Mailing Address - Fax:253-985-6812
Practice Address - Street 1:1708 YAKIMA AVE STE 203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5300
Practice Address - Country:US
Practice Address - Phone:253-382-8150
Practice Address - Fax:253-985-6812
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002563163WW0101X, 363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8939483OtherSTATE CRIME VICTIMS
WA9607680Medicaid
WAP00354459OtherMEDICARE RAILROAD
WA8939401OtherSTATE CRIME VICTIMS
WA0191324OtherSTATE L&I
WA0207828OtherSTATE L&I
WA1042540Medicaid
WA0191325OtherSTATE L&I
WA8939483OtherSTATE CRIME VICTIMS
WAP00354459OtherMEDICARE RAILROAD
WA8850175Medicare ID - Type Unspecified
WAG8850175Medicare PIN