MEDICARE: LYNN-TI JADE ALLEN LVN

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	164X00000X	Licensed Vocational Nurse	293275	CA

General Provider Information

NPI Number	:	1427917301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN-TI JADE ALLEN LVN

Provider Business Mailing Address
First Line	:	641 E 223RD ST UNIT C
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-8803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 E 223RD ST UNIT C
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-8803
Country	:	US
Telephone Number	:	404-494-5487
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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