Provider Demographics
NPI:1720044712
Name:POMPETTI, LYNNE C (APRN-BC CNS)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:C
Last Name:POMPETTI
Suffix:
Gender:F
Credentials:APRN-BC CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-569-4555
Mailing Address - Fax:817-569-4745
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4555
Practice Address - Fax:817-569-4745
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN112506 AP04739163WP0808X
TX579730364SP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMEDICARE 8L26312OtherMEDICARE
LAP83926Medicare UPIN
LAP83926Medicare UPIN