Provider Demographics
NPI:1356393961
Name:ROBBINS, LYNN M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:NAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12349 DE PAUL DR STE 100
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-291-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200173374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO970017208OtherRAILROAD MEDICARE
MO000085199Medicare ID - Type Unspecified
MO970017208OtherRAILROAD MEDICARE