Provider Demographics
NPI:1639836836
Name:CARSON, LINDSEY FAITH
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:FAITH
Last Name:CARSON
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 1:430 SCOTTY CARSON LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6483
Mailing Address - Country:US
Mailing Address - Phone:423-215-8419
Mailing Address - Fax:
Practice Address - Street 1:11735 SCOTT HWY
Practice Address - Street 2:
Practice Address - City:HELENWOOD
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-215-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty