Provider Demographics
NPI:1114211281
Name:GOLLNER, LINDSEY ERIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:ERIN
Last Name:GOLLNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:ERIN
Other - Last Name:CAVNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15320 HIGHWAY 105 STE 120
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-2602
Mailing Address - Country:US
Mailing Address - Phone:936-582-5660
Mailing Address - Fax:936-582-5661
Practice Address - Street 1:15320 HIGHWAY 105 STE 120
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-2602
Practice Address - Country:US
Practice Address - Phone:936-582-5660
Practice Address - Fax:936-582-5661
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical