Basic Information
| Provider Information | |||||||||
| NPI: | 1083617930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEGALL | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8888 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012594260 | ||||||||
| FaxNumber: | 9012592785 | ||||||||
| Practice Location | |||||||||
| Address1: | 6286 BRIARCREST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381204023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012591600 | ||||||||
| FaxNumber: | 9012592785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 462 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 620819926 | 01 | MS | BCBS | OTHER | 620819926 | 01 | TN | AETNA | OTHER | 3662313 | 05 | TN | MEDICAID | 3371161 | 05 | TN | MEDICAID | 620819926 | 01 | TN | CIGNA | OTHER | 4087060 | 01 | TN | BCBS | OTHER | 110318002 | 05 | AR | MEDICAID | 7187860 | 05 | MS | MEDICAID | P00152990 | 01 | TN | RAILROAD MEDICARE | OTHER | 4113352 | 01 | TN | BCBS | OTHER | 620819926 | 01 | TN | TRICARE | OTHER |