Provider Demographics
NPI:1568452134
Name:DUNSON, LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:DUNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK PL
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 HERITAGE CIR
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3744
Practice Address - Country:US
Practice Address - Phone:918-762-6546
Practice Address - Fax:918-762-4614
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO52158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1752158Medicaid
OK1752158Medicaid
OK8HG179Medicare PIN
OK820581687Medicare ID - Type UnspecifiedTAX ID
8HE127Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER