Provider Demographics
NPI:1851387864
Name:JARRELL, LYNDA LIZBETH
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:LIZBETH
Last Name:JARRELL
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 1:6202 QUEENSLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-6038
Mailing Address - Country:US
Mailing Address - Phone:979-450-9394
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST STE 220
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2507
Practice Address - Country:US
Practice Address - Phone:979-774-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily