Healthcare Provider Details

I. General information

NPI: 1194977330
Provider Name (Legal Business Name): KATELYN ELIZABETH LYNCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN ELIZABETH BENNETT PA-C

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 340
LANSING MI
48912-1894
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 340
LANSING MI
48912-1894
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5955
  • Fax: 517-364-5959
Mailing address:
  • Phone: 517-364-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: