Provider Demographics
NPI:1588221394
Name:OBERACKER, LINDSEY CATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:CATHERINE
Last Name:OBERACKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SUMNER DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5562
Mailing Address - Country:US
Mailing Address - Phone:814-860-6995
Mailing Address - Fax:
Practice Address - Street 1:217 GLENSFORD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0892
Practice Address - Country:US
Practice Address - Phone:910-483-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006527363A00000X
NC0010-10028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant