1194868216 NPI number — LYNETTE AUTIN LAWTON CRNA

Table of content: JADE ELIZABETH WITT (NPI 1962281246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194868216 NPI number — LYNETTE AUTIN LAWTON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWTON
Provider First Name:
LYNETTE
Provider Middle Name:
AUTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLOWERS
Provider Other First Name:
LYNETTE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194868216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840853
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-233-1999
Provider Business Mailing Address Fax Number:
972-233-3666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12222 MERIT DR STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-715-5000
Provider Business Practice Location Address Fax Number:
972-715-9976
Provider Enumeration Date:
02/15/2007

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: 367500000X , with the licence number:  686446 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AP114692 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 074287 . This is a "CRNA RECERTIFICATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 178840801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86222U . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 686446 . This is a "TSBNE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00315512 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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