Doctor Name: | LYNETTE BALTAS |
NPI Number: | 1710955869 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA00046 |
Business Practice Address: | 4770 Amoco Dr Moss Point, MS - 395639627 |
Business Phone Number: | 2284749511 |
Business Fax Number: | 2284752809 |
Mailing Address: | Po Box 475, BILOXI |
State: | MS |
Postal Code: | 39533 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/14/2006 |
NPI Last Update Date: | 08/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA00046 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |