Provider Demographics
NPI:1669848255
Name:NELSON, LYNDA DIANNA
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:DIANNA
Last Name:NELSON
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 1:636 POSSOM TROT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WHITEWRIGHT
Mailing Address - State:TX
Mailing Address - Zip Code:75491-7181
Mailing Address - Country:US
Mailing Address - Phone:903-364-5577
Mailing Address - Fax:
Practice Address - Street 1:636 POSSOM TROT HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WHITEWRIGHT
Practice Address - State:TX
Practice Address - Zip Code:75491-7181
Practice Address - Country:US
Practice Address - Phone:903-364-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253J00000X253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency