Provider Demographics
NPI:1225676703
Name:DISHMAN, LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12516 FARM ROAD 79
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:TX
Mailing Address - Zip Code:75486-5534
Mailing Address - Country:US
Mailing Address - Phone:903-491-1234
Mailing Address - Fax:
Practice Address - Street 1:12516 FARM ROAD 79
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:TX
Practice Address - Zip Code:75486-5534
Practice Address - Country:US
Practice Address - Phone:903-491-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty