Basic Information
Provider Information
NPI: 1649295742
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: LYNN
MiddleName: H
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 340
Address2:  
City: SPRINGFIELD
State: TN
PostalCode: 371720340
CountryCode: US
TelephoneNumber: 6156432706
FaxNumber: 6156432706
Practice Location
Address1: 100 NORTHCREST DR
Address2:  
City: SPRINGFIELD
State: TN
PostalCode: 371723927
CountryCode: US
TelephoneNumber: 6156432706
FaxNumber: 6156432706
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XAPN0000008722TNY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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