Individual
LYNN MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1500 SOUTHWEST BLVD, SUITE D, JEFFERSON CITY, MO 65109
(573) 632-5780
(573) 632-5833
Mailing address
1500 SOUTHWEST BLVD, SUITE D CAPITAL REGION FAMILY PHYSICIANS SOUTHWEST, JEFFERSON CITY, MO 65109
(573) 632-5780
(573) 632-5833
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
067194
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098246
CIGNA
—
01
—
114302
BLUE CROSS BLUE SHIELD
—
01
—
338310
HEALTHLINK
—
05
—
42582680
—
MO
Enumeration date
02/08/2006
Last updated
06/26/2012
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