Healthcare Provider Details

I. General information

NPI: 1811699234
Provider Name (Legal Business Name): DR. LYNE M ETCHOUEKANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E FM 544 STE 112
MURPHY TX
75094-4080
US

IV. Provider business mailing address

170 E FM 544 STE 112
MURPHY TX
75094-4080
US

V. Phone/Fax

Practice location:
  • Phone: 469-626-3215
  • Fax: 469-626-3117
Mailing address:
  • Phone: 469-626-3215
  • Fax: 469-626-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW6224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: