Provider Demographics
NPI:1043376544
Name:KENNY W. LYNN, M.D.
Entity Type:Organization
Organization Name:KENNY W. LYNN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-7418
Mailing Address - Street 1:210 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2419
Mailing Address - Country:US
Mailing Address - Phone:931-528-7418
Mailing Address - Fax:931-525-6165
Practice Address - Street 1:210 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2419
Practice Address - Country:US
Practice Address - Phone:931-528-7418
Practice Address - Fax:931-525-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10796OtherMEDICAL LICENSE
TN3174362Medicaid
TN3174362Medicare ID - Type Unspecified