Provider Demographics
NPI:1972598548
Name:LYNN, MELISSA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2751 ALBERT BICKNELL DRIVE
Mailing Address - Street 2:STE 3C
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3943
Mailing Address - Country:US
Mailing Address - Phone:318-000-0000
Mailing Address - Fax:318-000-0000
Practice Address - Street 1:2751 ALBERT BICKNELL DRIVE
Practice Address - Street 2:STE 3C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3943
Practice Address - Country:US
Practice Address - Phone:318-000-0000
Practice Address - Fax:318-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2014-12-26
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Provider Licenses
StateLicense IDTaxonomies
LA020492207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107235703OtherTEXAS MEDICAID
LA1967327Medicaid
LA720702002LYOtherOCHSNER
A011OtherCHAMPUS
130022957OtherRAILROAD MEDICARE
LAF89082Medicare UPIN
LAF89082Medicare UPIN