Provider Demographics
NPI:1073232013
Name:PENDERGRASS, LINDSEY PAIGE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:PAIGE
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 BRISTOL CAVERNS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-9456
Mailing Address - Country:US
Mailing Address - Phone:276-698-6009
Mailing Address - Fax:
Practice Address - Street 1:5554 HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4435
Practice Address - Country:US
Practice Address - Phone:423-666-0030
Practice Address - Fax:423-666-0031
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily