MEDICARE: CIERA LYNCH FNP-C

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	163WS0121X	Plastic Surgery Registered Nurse	872874	TX

General Provider Information

NPI Number	:	1255096814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERA LYNCH FNP-C

Provider Business Mailing Address
First Line	:	910 W COUTS ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5137
Country	:	US
Telephone Number	:	817-682-4066
Fax Number	:

Provider Business Practice Location Address
First Line	:	5825 EDWARDS RANCH RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3577
Country	:	US
Telephone Number	:	817-870-5080
Fax Number	:

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

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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