Provider Demographics
NPI:1831768555
Name:FRIEND, LYNAE RACHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:LYNAE
Middle Name:RACHELLE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LYNAE
Other - Middle Name:RACHELLE
Other - Last Name:GEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18614 JACKSON STREET
Mailing Address - Street 2:PO BOX 125
Mailing Address - City:HERMITAGE
Mailing Address - State:MO
Mailing Address - Zip Code:65668
Mailing Address - Country:US
Mailing Address - Phone:833-789-5933
Mailing Address - Fax:417-745-0056
Practice Address - Street 1:1100 SOUTH SPRINGFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-7272
Practice Address - Fax:417-326-2193
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021016655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health