Provider Demographics
NPI:1609880392
Name:SMITH, LYNN R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:LANGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1039 MANSHIP ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2133
Mailing Address - Country:US
Mailing Address - Phone:601-354-4073
Mailing Address - Fax:601-368-3917
Practice Address - Street 1:1500 E.WOODROW WILSON
Practice Address - Street 2:G.V. (SONNY) MONTGOMERY, VAMC; NURSING SERVICE (118)
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-368-3917
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR519456363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health