Provider Demographics
NPI:1083663843
Name:NIX, LINDSEY BROOKE (PA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:BROOKE
Last Name:NIX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 WESTLAND DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5294
Mailing Address - Country:US
Mailing Address - Phone:865-671-3888
Mailing Address - Fax:865-671-4911
Practice Address - Street 1:9700 WESTLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5294
Practice Address - Country:US
Practice Address - Phone:865-671-3888
Practice Address - Fax:865-671-4911
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376258Medicaid
TN3662230Medicare ID - Type Unspecified
TN3376258Medicaid