Provider Demographics
NPI:1083617930
Name:STEGALL, LYNN ANNETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANNETTE
Last Name:STEGALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8888
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8888
Mailing Address - Country:US
Mailing Address - Phone:901-259-4260
Mailing Address - Fax:901-259-2785
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-1600
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN462363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS620819926OtherBCBS
TN620819926OtherAETNA
TN3662313Medicaid
TN3371161Medicaid
TN620819926OtherCIGNA
TN4087060OtherBCBS
AR110318002Medicaid
MS7187860Medicaid
TNP00152990OtherRAILROAD MEDICARE
TN4113352OtherBCBS
TN620819926OtherTRICARE
TN4113352OtherBCBS
TNQ17341Medicare UPIN
TN3662313Medicare PIN