Provider Demographics
NPI:1710926886
Name:LYNCH, REBECCA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-0218
Mailing Address - Country:US
Mailing Address - Phone:918-272-0033
Mailing Address - Fax:918-272-0039
Practice Address - Street 1:12410 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2500
Practice Address - Country:US
Practice Address - Phone:918-272-0033
Practice Address - Fax:918-272-0039
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200343740AMedicaid
OK200343740AMedicaid
KSI55403Medicare UPIN