1174963854 NPI number — MRS. LINDSAY DRIVER CLARKE PA-C

Table of content: MRS. LINDSAY DRIVER CLARKE PA-C (NPI 1174963854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174963854 NPI number — MRS. LINDSAY DRIVER CLARKE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARKE
Provider First Name:
LINDSAY
Provider Middle Name:
DRIVER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DRIVER
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174963854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 CREEDMOOR ROAD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-518-0999
Provider Business Mailing Address Fax Number:
919-518-0939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 CREEDMOOR RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-518-0999
Provider Business Practice Location Address Fax Number:
919-518-0939
Provider Enumeration Date:
06/26/2013

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: 363A00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NCK59D804 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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