Individual
LYNDA DIANNE BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
101 FK BUSTER AVE, CHEYENNE, OK 73628
(580) 497-3333
(580) 497-2778
Mailing address
PO BOX 490, CHEYENNE, OK 73628-0490
(580) 497-3333
(580) 497-2778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA912
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100161610A
—
OK
Enumeration date
07/13/2006
Last updated
04/18/2016
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