Provider Demographics
NPI:1992133979
Name:CRITES, LYNN (FNP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:CRITES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KYNN
Other - Middle Name:MARIE
Other - Last Name:SANDFORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2022
Mailing Address - Country:US
Mailing Address - Phone:416-256-2111
Mailing Address - Fax:417-256-4858
Practice Address - Street 1:805 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2022
Practice Address - Country:US
Practice Address - Phone:416-256-2111
Practice Address - Fax:417-256-4858
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013038949OtherLICENSE