Healthcare Provider Details

I. General information

NPI: 1932604808
Provider Name (Legal Business Name): LYNNA G HUNT BSRT,RDMS,RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 03/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 NW 23RD ST
BETHANY OK
73008-4921
US

IV. Provider business mailing address

13401 GOLDEN EAGLE DR
EDMOND OK
73013-7404
US

V. Phone/Fax

Practice location:
  • Phone: 405-787-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number17667
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number17667
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: