Provider Demographics
NPI:1396212981
Name:EDWARDS, LYNDSAY JENSEN (PA)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:JENSEN
Last Name:EDWARDS
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 1:86 N MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-6502
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:
Practice Address - Street 1:11728 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8954
Practice Address - Country:US
Practice Address - Phone:828-766-7778
Practice Address - Fax:828-688-1334
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant