Healthcare Provider Details

I. General information

NPI: 1023249497
Provider Name (Legal Business Name): LYNN ANN VINCENT ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR SUITE 61
JACKSON MS
39216-4635
US

IV. Provider business mailing address

970 LAKELAND DR SUITE 61
JACKSON MS
39216-4635
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-7850
  • Fax: 601-366-8507
Mailing address:
  • Phone: 601-982-7850
  • Fax: 601-366-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR724394
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: