Provider Demographics
NPI:1487271904
Name:PRICKETT, LYNETTE (ARNP, NP-C)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15346 DODGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPERRY
Mailing Address - State:IA
Mailing Address - Zip Code:52650-9623
Mailing Address - Country:US
Mailing Address - Phone:319-470-6027
Mailing Address - Fax:
Practice Address - Street 1:15346 DODGEVILLE RD
Practice Address - Street 2:
Practice Address - City:SPERRY
Practice Address - State:IA
Practice Address - Zip Code:52650-9623
Practice Address - Country:US
Practice Address - Phone:319-470-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA159313363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner