Provider Demographics
NPI:1609089481
Name:BOCKMON, LYNDA ELIZABETH (ANP-BC, ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:ELIZABETH
Last Name:BOCKMON
Suffix:
Gender:F
Credentials:ANP-BC, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2031
Mailing Address - Country:US
Mailing Address - Phone:903-533-8702
Mailing Address - Fax:
Practice Address - Street 1:1040 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2031
Practice Address - Country:US
Practice Address - Phone:903-533-8702
Practice Address - Fax:903-533-8720
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718484363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560448001OtherBLUE CROSS BLUE SHIELD
TX189237401Medicaid
TX752616977008OtherTRICARE
TX8Y2322OtherBCBS
NY01951633Medicaid
NY000560448001OtherBLUE CROSS BLUE SHIELD
NYS88657Medicare UPIN
TX189237401Medicaid