MEDICARE: MRS. LYNN MARIE STARK APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2017017205	MO
2	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	125321	MO

General Provider Information

NPI Number	:	1033260013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN MARIE STARK APRN

Provider Business Mailing Address
First Line	:	4801 WELDON SPRING PKWY # 300
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 WELDON SPRING PKWY # 300
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	11/09/2022

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