1609620657 NPI number — MRS. LINDSAY JEANNE LAWRENCE ECDS

Table of content: MRS. LINDSAY JEANNE LAWRENCE ECDS (NPI 1609620657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609620657 NPI number — MRS. LINDSAY JEANNE LAWRENCE ECDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
LINDSAY
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ECDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CULP
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
JEANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609620657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 AVONDALE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72301-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-733-9950
Provider Business Mailing Address Fax Number:
870-733-9966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 AVONDALE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301-1794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-733-9950
Provider Business Practice Location Address Fax Number:
870-733-9966
Provider Enumeration Date:
04/16/2024

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: 2080P0006X , with the licence number:  9274387 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Q00000X , with the licence number: 9274387 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841416716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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