MEDICARE: MS. LYNDA MARIE MCKENRY ARNP CNM

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	364S00000X	Clinical Nurse Specialist	ARNP 3104782	FL

General Provider Information

NPI Number	:	1770779068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNDA MARIE MCKENRY ARNP CNM

Provider Business Mailing Address
First Line	:	5422 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3948
Country	:	US
Telephone Number	:	727-849-1659
Fax Number	:	727-842-3627

Provider Business Practice Location Address
First Line	:	5422 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3948
Country	:	US
Telephone Number	:	727-849-1659
Fax Number	:	727-842-3627

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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