Healthcare Provider Details

I. General information

NPI: 1184611139
Provider Name (Legal Business Name): ELLA OLEHONNA LYNCH FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 OLD MAIN RD
PEMBROKE NC
28372-8753
US

IV. Provider business mailing address

PO BOX 3605
PEMBROKE NC
28372-3605
US

V. Phone/Fax

Practice location:
  • Phone: 910-775-9201
  • Fax: 910-521-8540
Mailing address:
  • Phone: 910-740-3508
  • Fax: 910-521-8540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0050-00705
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5000705
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: