Provider Demographics
NPI:1427455757
Name:LYNN, DUSTY (SA-C)
Entity type:Individual
Prefix:
First Name:DUSTY
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110339
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0339
Mailing Address - Country:US
Mailing Address - Phone:615-831-3711
Mailing Address - Fax:615-831-3713
Practice Address - Street 1:1810 TOLIVER TRCE
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4940
Practice Address - Country:US
Practice Address - Phone:615-831-3711
Practice Address - Fax:615-831-3713
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant