Provider Demographics
NPI:1831412147
Name:CARLYLE, LYNDA G (FNP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:G
Last Name:CARLYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-3821
Mailing Address - Country:US
Mailing Address - Phone:573-378-2351
Mailing Address - Fax:660-826-1300
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3821
Practice Address - Country:US
Practice Address - Phone:660-310-0909
Practice Address - Fax:660-826-1300
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540568508Medicaid
MO1831412147Medicaid
43747026OtherBCBS
MO595985805Medicaid
43747016OtherBCBS
MO595956103Medicaid
P270000Medicare PIN
268550Medicare Oscar/Certification
268548Medicare Oscar/Certification
261320Medicare Oscar/Certification
43747026OtherBCBS