Provider Demographics
NPI:1992030928
Name:LYNN, STACY (NP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:LYNN
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 1:492 DANTE VILLA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-5689
Mailing Address - Country:US
Mailing Address - Phone:208-251-2524
Mailing Address - Fax:
Practice Address - Street 1:492 DANTE VILLA ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-5689
Practice Address - Country:US
Practice Address - Phone:208-251-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002018363LF0000X
IDNP-935A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1992030928Medicaid
NV1992030928Medicaid