1497926265 NPI number — MRS. LINDY COCHRAN WINDHAM CFNP

Table of content: MRS. LINDY COCHRAN WINDHAM CFNP (NPI 1497926265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497926265 NPI number — MRS. LINDY COCHRAN WINDHAM CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINDHAM
Provider First Name:
LINDY
Provider Middle Name:
COCHRAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASSELL
Provider Other First Name:
LINDY
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497926265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HIGHWAY 535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINARY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39479-8809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-772-3208
Provider Business Mailing Address Fax Number:
601-772-3304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 N 15TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-323-1920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2008

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: 363LF0000X , with the licence number:  R865733 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02604808 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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