Provider Demographics
NPI:1780741223
Name:CASTLE, LYNN KRISTY (PAC)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:KRISTY
Last Name:CASTLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:207 KATHRYN DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6113
Mailing Address - Country:US
Mailing Address - Phone:865-850-7661
Mailing Address - Fax:865-305-9168
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:SUITE 240
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-9620
Practice Address - Fax:865-305-9168
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTND00000001152207Q00000X
TNPA0000000556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58154Medicare UPIN