Provider Demographics
NPI:1588428395
Name:BRADY, LYNNE M (FNP-BC)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:FNP-BC
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 1476
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1476
Mailing Address - Country:US
Mailing Address - Phone:601-278-0070
Mailing Address - Fax:
Practice Address - Street 1:200 PIONEER TRAIL
Practice Address - Street 2:
Practice Address - City:RED RIVER
Practice Address - State:NM
Practice Address - Zip Code:87558
Practice Address - Country:US
Practice Address - Phone:575-754-6330
Practice Address - Fax:575-754-7168
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily