Provider Demographics
NPI:1396790846
Name:LYNN, KENIA S (PA)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:S
Last Name:LYNN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:8950 N KENDALL DR
Mailing Address - Street 2:SUITE 504W
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2144
Mailing Address - Country:US
Mailing Address - Phone:305-274-2030
Mailing Address - Fax:305-279-0878
Practice Address - Street 1:8950 N KENDALL DR
Practice Address - Street 2:SUITE 504W
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:305-274-2030
Practice Address - Fax:305-279-0878
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP84720Medicare UPIN
FLU3892AMedicare ID - Type Unspecified