Healthcare Provider Details

I. General information

NPI: 1861400608
Provider Name (Legal Business Name): LYNN ANN OUTLAW PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN ANN PHILLIPS

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

IV. Provider business mailing address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5000
  • Fax: 417-761-5011
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA003827
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN233411
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000017442
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP02209
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG129605
License Number StateIA
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209022174
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2012033855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: