Healthcare Provider Details

I. General information

NPI: 1952311342
Provider Name (Legal Business Name): LYNN V COULTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 N JOSEY LN STE 160
CARROLLTON TX
75010-4676
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 972-492-4242
  • Fax: 972-394-1282
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK2197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: