Healthcare Provider Details

I. General information

NPI: 1114044542
Provider Name (Legal Business Name): CHRISTOPHER ROBERT LYNCH CST,CSFA, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 SW LOOP 820
FORT WORTH TX
76109-5350
US

IV. Provider business mailing address

PO BOX 101292
FORT WORTH TX
76185-1292
US

V. Phone/Fax

Practice location:
  • Phone: 817-852-6927
  • Fax: 817-531-2939
Mailing address:
  • Phone: 817-852-6927
  • Fax: 817-531-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number808232
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number151900
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number100964
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: