Provider Demographics
NPI:1194012922
Name:TYRRELL, LINDSEY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ANN
Other - Last Name:KOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:3760 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062
Mailing Address - Country:US
Mailing Address - Phone:610-966-4646
Mailing Address - Fax:610-965-6201
Practice Address - Street 1:3760 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1741
Practice Address - Country:US
Practice Address - Phone:610-966-4646
Practice Address - Fax:610-965-6201
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054936363AM0700X
PAOA002676363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA279788Medicare PIN