Healthcare Provider Details

I. General information

NPI: 1669773404
Provider Name (Legal Business Name): CAROLINE KAYE LYNN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MALCOLM BLVD
VALDESE NC
28690-2872
US

IV. Provider business mailing address

720 MALCOLM BLVD
VALDESE NC
28690-2872
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-7536
  • Fax: 828-580-7537
Mailing address:
  • Phone: 828-580-7536
  • Fax: 828-580-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number191652
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5004695
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: