MEDICARE: MS. LYNNE C POMPETTI APRN-BC CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN112506 AP04739	LA
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	579730	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICARE 8L26312	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1720044712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNNE C POMPETTI APRN-BC CNS

Provider Business Mailing Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4555
Fax Number	:	817-569-4745

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4555
Fax Number	:	817-569-4745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/04/2016

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