Provider Demographics
NPI:1124010129
Name:DOLAN, LINDY M (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:M
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184587702Medicaid
TX184587701Medicaid
TX8859NHOtherBCBS
TX752616977042OtherTRICARE
TX87N687OtherBCBS OF TEXAS
TXP01421804OtherRAIL ROAD MEDICARE
P06777Medicare UPIN
86N431Medicare ID - Type Unspecified
TX752616977042OtherTRICARE
TXP00387528Medicare PIN