Provider Demographics
NPI:1396790846
Name:LYNN, KENIA S (PA)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:S
Last Name:LYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-662-7980
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR STE 504W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2127
Practice Address - Country:US
Practice Address - Phone:305-274-2030
Practice Address - Fax:786-535-7053
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP84720Medicare UPIN
FLU3892AMedicare ID - Type Unspecified