Provider Demographics
NPI:1972833069
Name:OBST, LYNNE MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:OBST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2497
Mailing Address - Country:US
Mailing Address - Phone:502-459-9127
Mailing Address - Fax:502-238-3653
Practice Address - Street 1:4606 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3726
Practice Address - Country:US
Practice Address - Phone:502-937-2209
Practice Address - Fax:502-933-8714
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY6299P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00150011Medicare PIN
KY1200921Medicare PIN
KY0791211Medicare PIN
KY0249114Medicare PIN