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NPI Code Detail

MEDICARE: MRS. LYNNDA JEAN GARRETT APMHNP

MEDICARE: MRS. LYNNDA JEAN GARRETT APMHNP
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
1163W00000XRegistered NurseR899668MS
2163W00000XRegistered Nurse537491CA
3163WC1500XCommunity Health Registered Nurse59939CA
4363LP0808XPsychiatric/Mental Health Nurse PractitionerR899668MS
5363LP0808XPsychiatric/Mental Health Nurse Practitioner16282CA
6364SP0809XAdult Psychiatric/Mental Health Clinical Nurse Specialist2428CA

General Provider Information

NPI Number : 1548655798
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNNDA JEAN GARRETT APMHNP
Provider Business Mailing Address
First Line : 3340 SERENITY PL
Second Line :
City : ROCK ISLAND
State : IL
Zip : 61201-2027
Country : US
Telephone Number : 951-212-0475
Fax Number :
Provider Business Practice Location Address
First Line : 2560 24TH ST
Second Line : STE 101
City : ROCK ISLAND
State : IL
Zip : 61201-5357
Country : US
Telephone Number : 951-212-0475
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2015
Last Update Date : 03/21/2017

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