Provider Demographics
NPI:1558039859
Name:LINDSAY, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3711 MARIE COOK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-1509
Mailing Address - Country:US
Mailing Address - Phone:334-300-4548
Mailing Address - Fax:
Practice Address - Street 1:3711 MARIE COOK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-1509
Practice Address - Country:US
Practice Address - Phone:334-300-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program