1457861478 NPI number — LINDSAY REBECCA BIRCH MSN, ACNPC-AG, NP-C

Table of content: LINDSAY REBECCA BIRCH MSN, ACNPC-AG, NP-C (NPI 1457861478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457861478 NPI number — LINDSAY REBECCA BIRCH MSN, ACNPC-AG, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRCH
Provider First Name:
LINDSAY
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, ACNPC-AG, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457861478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 UNION AVE STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104-6655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-478-9183
Provider Business Mailing Address Fax Number:
901-478-8993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-478-9183
Provider Business Practice Location Address Fax Number:
901-478-8993
Provider Enumeration Date:
10/04/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  902151 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 25023 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6191130 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01786701 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 234220758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q048360 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".