1386603207 NPI number — MRS. LYNNETTE JEWEL CARRENS WHNP

Table of content: MRS. LYNNETTE JEWEL CARRENS WHNP (NPI 1386603207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386603207 NPI number — MRS. LYNNETTE JEWEL CARRENS WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRENS
Provider First Name:
LYNNETTE
Provider Middle Name:
JEWEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386603207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N TOM GREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79761-5145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-580-9876
Provider Business Mailing Address Fax Number:
432-580-9877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N TOM GREEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-5145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-580-9876
Provider Business Practice Location Address Fax Number:
432-580-9877
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LW0102X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R56311 . This is a "CERTIFIED NURSE PRACTITIO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1434540 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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