Individual provider Active NPI

Willard Dean Lynch, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1801377601
Registry record updated Sep 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP11725 Issued in AZ
Practice address
39580 S Lago del Oro Pkwy
Tucson, AZ 85739
Phone
(520) 624-4000
NPI assigned
Aug 28, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP11725 AZ Primary

Addresses

Primary practice location

39580 S Lago del Oro Pkwy
Tucson, AZ 85739

Mailing address

3480 W Northstar Dr
Tucson, AZ 85741-2440
Phone (520) 241-1426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190208002938 AZ Practitioner - Nurse Practitioner 7911245386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1735 E Fort Lowell Rd
Suite 6
Tucson, AZ 85719-2358
Phone (520) 551-6053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP11725AZMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Behavioral Health Hospital, LLC Current Accepting new patients
Willard Lynch Pmhnp-BC, PLLC CurrentSince Jan 1, 2020 Accepting new patients
Sonora Behavioral Health Hospital, LLC CurrentSince Sep 10, 2018 Accepting new patients

Locations

6050 N Corona Rd
Tucson, AZ 85704
Phone (520) 469-8700

4735 N 1st Ave
Tucson, AZ 85718
Phone (520) 829-5689

1735 E Fort Lowell Rd
Ste 6
Tucson, AZ 85719
Phone (210) 410-4995

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535932800000",
    "number": "1801377601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 W NORTHSTAR DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857412440",
            "telephone_number": "520-241-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39580 S LAGO DEL ORO PKWY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85739",
            "telephone_number": "520-624-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "WILLARD",
        "middle_name": "DEAN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "AP11725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.