Provider Demographics
NPI:1528075124
Name:JENNINGS, LYNN KARIN (MD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:KARIN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-315-4119
Mailing Address - Fax:903-315-4130
Practice Address - Street 1:1600 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-5040
Practice Address - Country:US
Practice Address - Phone:903-315-5630
Practice Address - Fax:903-845-6212
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122331505Medicaid