Provider Demographics
NPI:1548366339
Name:BRATTON, LYNNETTE A (NP)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:A
Last Name:BRATTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 N 500 W
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47952-7237
Mailing Address - Country:US
Mailing Address - Phone:765-592-1622
Mailing Address - Fax:765-498-1622
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-3000
Practice Address - Fax:217-554-5780
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309.004984363LF0000X
IN71000171A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN829580P4Medicare ID - Type Unspecified