Provider Demographics
NPI:1366464620
Name:LYNN, CONNIE G (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:G
Last Name:LYNN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17C BRENTSHIRE SQUARE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2273
Mailing Address - Country:US
Mailing Address - Phone:731-664-1717
Mailing Address - Fax:731-664-7114
Practice Address - Street 1:17C BRENTSHIRE SQUARE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2273
Practice Address - Country:US
Practice Address - Phone:731-664-1717
Practice Address - Fax:731-664-7114
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050897367500000X
TN79059367500000X
TN9522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507512Medicaid
KY74001009Medicaid
TN1511639Medicaid
TN1507512Medicaid
KY0735718Medicare PIN
KY0601372Medicare PIN