Provider Demographics
NPI:1295006476
Name:HEAD, LINDSEY ERIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:ERIN
Last Name:HEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:410 4TH ST
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2372
Mailing Address - Country:US
Mailing Address - Phone:580-430-3328
Mailing Address - Fax:580-430-3376
Practice Address - Street 1:410 4TH ST
Practice Address - Street 2:SUITES A & B
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2372
Practice Address - Country:US
Practice Address - Phone:580-430-3328
Practice Address - Fax:580-430-3376
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200458820AMedicaid
OKOKA105889Medicare PIN