Provider Demographics
NPI:1417547886
Name:LYNCH, KAYLEEN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLEEN
Middle Name:ELIZABETH
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KAYLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8081 INNOVATION PARK DR STE 900
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4867
Mailing Address - Country:US
Mailing Address - Phone:571-472-4200
Mailing Address - Fax:571-472-4201
Practice Address - Street 1:8081 INNOVATION PARK DR STE 900
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4200
Practice Address - Fax:571-472-4201
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant