| Organization Name: | R LYNN CARLSON P.C.M.D. |
| NPI Number: | 1215385794 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH A HURLEY (EXECUTIVE DIRECTOR) |
| Mailing Address: | 43785 Kenai Spur Hwy Kenai |
| State: | AK US |
| Postal Code: | 99611 |
| Phone Number: | 9072839116 |
| Fax Number: | 9073352461 |
| NPI Enumeration Date: | 05/25/2016 |
| NPI Last Update Date: | 05/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PADA895 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |