Provider Demographics
NPI:1740422013
Name:LYNN, CAROL (PMHNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 KENNON RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3032
Mailing Address - Country:US
Mailing Address - Phone:865-804-9741
Mailing Address - Fax:865-339-3432
Practice Address - Street 1:314 KENNON RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3032
Practice Address - Country:US
Practice Address - Phone:865-804-9741
Practice Address - Fax:865-339-3432
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14195363LP0808X, 363LP0808X
ID59379363LP0808X
IAG150637363LP0808X
MT131735363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ057509Medicaid