Provider Demographics
NPI:1326732041
Name:EVANS, LINDSEY JOY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JOY
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 KEISER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3326
Mailing Address - Country:US
Mailing Address - Phone:484-509-0840
Mailing Address - Fax:610-678-2100
Practice Address - Street 1:2607 KEISER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3326
Practice Address - Country:US
Practice Address - Phone:484-509-0840
Practice Address - Fax:610-678-2100
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026703363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104178368Medicaid