Provider Demographics
NPI:1952484115
Name:TODD, LYNNE BAILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:BAILEY
Last Name:TODD
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 1:7421 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7348
Mailing Address - Country:US
Mailing Address - Phone:919-921-0865
Mailing Address - Fax:
Practice Address - Street 1:3404 WAKE FOREST RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7341
Practice Address - Country:US
Practice Address - Phone:919-549-3050
Practice Address - Fax:919-613-2335
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101341363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762779Medicare ID - Type Unspecified
Q36137Medicare ID - Type Unspecified