Provider Demographics
NPI:1629568480
Name:LYNN, HEATHER KAY (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KAY
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 FRANKLIN HEALTH COMMONS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938
Mailing Address - Country:US
Mailing Address - Phone:207-778-0482
Mailing Address - Fax:207-778-0133
Practice Address - Street 1:181 FRANKLIN HEALTH COMMONS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938
Practice Address - Country:US
Practice Address - Phone:207-778-0482
Practice Address - Fax:207-778-0133
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL52350208000000X
MEMD25034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics