Provider Demographics
NPI:1285654020
Name:DYKSTRA, LYNN ANN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3109
Mailing Address - Country:US
Mailing Address - Phone:406-752-8300
Mailing Address - Fax:406-752-3542
Practice Address - Street 1:1273 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3109
Practice Address - Country:US
Practice Address - Phone:406-752-8300
Practice Address - Fax:406-752-3542
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0066495Medicaid
MT95755OtherBLUE CROSS