Provider Demographics
NPI:1316981509
Name:LYNE, JOHN F (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:LYNE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6819 PLUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1602
Mailing Address - Country:US
Mailing Address - Phone:806-367-8072
Mailing Address - Fax:806-354-0147
Practice Address - Street 1:6819 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1602
Practice Address - Country:US
Practice Address - Phone:903-654-6812
Practice Address - Fax:806-354-0147
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX447979367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A5669Medicare ID - Type Unspecified