Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN071414 | GA |
NPI | 1003889825 |
---|---|
Provider Name | Ms. Allen R Lybrook |
First Address | Thomasville, GA 31792-6605 |
Second Address | Thomasville, GA 31792-6605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 14/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00804152B | (05) | GA |
D53030 | (02) | GA |