Provider Demographics
NPI:1275981086
Name:WHITEHEAD, LINDSEY (PA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WHITEHEAD
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 1:1411 7TH ST
Mailing Address - Street 2:APT 514
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2683
Mailing Address - Country:US
Mailing Address - Phone:970-988-5976
Mailing Address - Fax:
Practice Address - Street 1:1411 7TH ST
Practice Address - Street 2:APT 514
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2683
Practice Address - Country:US
Practice Address - Phone:970-988-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant