MEDICARE: JENNIFER JEAN LYNCH PMHNP-BC

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	2023206587	IL

General Provider Information

NPI Number	:	1043073455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEAN LYNCH PMHNP-BC

Provider Business Mailing Address
First Line	:	555 S PERRYVILLE RD STE 130
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2527
Country	:	US
Telephone Number	:	815-396-8617
Fax Number	:	815-201-8752

Provider Business Practice Location Address
First Line	:	555 S PERRYVILLE RD STE 130
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2527
Country	:	US
Telephone Number	:	815-396-8617
Fax Number	:	815-201-8752

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	06/24/2025

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