Provider Demographics
NPI:1548473325
Name:LYNCH, STEPHANIE ROSE (FNP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ROSE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13729
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3729
Mailing Address - Country:US
Mailing Address - Phone:575-621-8555
Mailing Address - Fax:575-521-1169
Practice Address - Street 1:540 WALTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8433
Practice Address - Country:US
Practice Address - Phone:575-525-2700
Practice Address - Fax:575-524-2045
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR52214363LP0808X
NMCNP01270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92875246Medicaid
NM92875246Medicaid