Provider Demographics
NPI:1194977330
Name:LYNCH, KATELYN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELIZABETH
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1200 E MICHIGAN AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1894
Mailing Address - Country:US
Mailing Address - Phone:517-364-5955
Mailing Address - Fax:
Practice Address - Street 1:1200 E MICHIGAN AVE STE 340
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1894
Practice Address - Country:US
Practice Address - Phone:517-364-5955
Practice Address - Fax:517-364-5959
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant