Healthcare Provider Details

I. General information

NPI: 1467191692
Provider Name (Legal Business Name): LYNN KUTLER PHD, RN, FMCHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2022
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 TURTLE CREEK BLVD APT 6B
DALLAS TX
75219-5515
US

IV. Provider business mailing address

3525 TURTLE CREEK BLVD APT 6B
DALLAS TX
75219-5515
US

V. Phone/Fax

Practice location:
  • Phone: 214-906-6309
  • Fax:
Mailing address:
  • Phone: 214-906-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number246367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: