Provider Demographics
NPI:1699226886
Name:LYNCH, KACI M (FNP-C)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:M
Other - Last Name:HENTRUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4700
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-6686
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006638A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily