Provider Demographics
NPI:1548655798
Name:GARRETT, LYNNDA JEAN (APMHNP)
Entity type:Individual
Prefix:MRS
First Name:LYNNDA
Middle Name:JEAN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:APMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 SERENITY PL
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-2027
Mailing Address - Country:US
Mailing Address - Phone:951-212-0475
Mailing Address - Fax:
Practice Address - Street 1:2560 24TH ST
Practice Address - Street 2:STE 101
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5357
Practice Address - Country:US
Practice Address - Phone:951-212-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR899668163W00000X, 363LP0808X
CA537491163W00000X
CA59939163WC1500X
CA16282363LP0808X
CA2428364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult