Provider Demographics
NPI:1578956546
Name:KLETT, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:KLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7025
Mailing Address - Country:US
Mailing Address - Phone:336-272-9447
Mailing Address - Fax:336-272-2112
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-272-9447
Practice Address - Fax:336-272-2112
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007524363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics