MEDICARE: KELLY LYNCH PMHNP

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	95027832	CA

General Provider Information

NPI Number	:	1780452326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNCH PMHNP

Provider Business Mailing Address
First Line	:	430 FOREST HILLS DR
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1462
Country	:	US
Telephone Number	:	760-861-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 FOREST HILLS DR
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-1462
Country	:	US
Telephone Number	:	760-861-7688
Fax Number	:

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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