Provider Demographics
NPI: | 1629343975 |
---|---|
Name: | WILLIFORD, LINDSEY (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | LINDSEY |
Middle Name: | |
Last Name: | WILLIFORD |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | DEPT. 453 PO BOX 1000 |
Mailing Address - Street 2: | |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38148-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-350-2163 |
Mailing Address - Fax: | 828-350-2174 |
Practice Address - Street 1: | 14 MCDOWELL ST |
Practice Address - Street 2: | |
Practice Address - City: | ASHEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28801-4104 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-255-3749 |
Practice Address - Fax: | 828-255-3749 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-03-20 |
Last Update Date: | 2022-08-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 5008768 | 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 1629343975 | Medicaid | |
NC | NCU988B | Other | MEDICARE PTAN |