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General NPI Number Information
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NPI Number | 1881243129
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Entity Type | Individual
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Provider Name | CASIDEE R LYNCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 6912 TRAILRIDE WAY
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-3323
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Country | US
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Telephone | 916-838-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 DUPONT RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-4610
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Country | US
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Telephone | 502-883-0227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TC084
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License Number State |
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