Individual provider Active NPI

Lynne Connelly, N.N.P.

  • Critical Care Neonatal Nurse Practitioner
  • Frisco, TX
National Provider Identifier
1063478881
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X
License
110688 Issued in TX
Practice address
12505 Lebanon Rd
Frisco, TX 75035-8298
Phone
(214) 343-6663
Fax
(214) 343-2814
NPI assigned
Apr 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 642405 TX
Critical Care Neonatal Nurse Practitioner 363LN0005X 110688 TX Primary

Addresses

Primary practice location

12505 Lebanon Rd
Frisco, TX 75035-8298

Mailing address

1121 E Spring Creek Pkwy
Ste. 110, #319
Plano, TX 75074
Phone (214) 343-6663

Other identifiers 1

IdentifierTypeStateIssuer
642405OtherTXLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
642405TXMDCritical Care Medicine Nurse Practitioner
110688TXMDCritical Care Neonatal Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1063478881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 E SPRING CREEK PKWY",
            "address_2": "STE. 110, #319",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "75074",
            "telephone_number": "214-343-6663",
            "fax_number": "214-343-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 LEBANON RD",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750358298",
            "telephone_number": "214-343-6663",
            "fax_number": "214-343-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "LYNNE",
        "credential": "N.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "TX",
            "license": "642405",
            "primary": false
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "TX",
            "license": "110688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "642405",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.