Healthcare Provider Details

I. General information

NPI: 1164522785
Provider Name (Legal Business Name): LYNN BEATTY ATHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN A BEATTY MD

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NW HIGHWAY 101 STE A
LINCOLN CITY OR
97367-3241
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-996-7480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301061662
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61187277
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD197669
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: