Provider Demographics
NPI:1699860965
Name:LYNDE, LEIGH (NP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:LYNDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S DENTON TAP RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4098
Mailing Address - Country:US
Mailing Address - Phone:972-462-0762
Mailing Address - Fax:972-393-2133
Practice Address - Street 1:580 S DENTON TAP RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:972-462-0762
Practice Address - Fax:972-393-2133
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX255785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184669301Medicaid
TX184669303Medicaid
TX184669303Medicaid
TX8J2807Medicare PIN
TXQ76648Medicare UPIN