Provider Demographics
NPI:1689139628
Name:CHAMPAGNE, LINDSEY HENDERSON (NP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:HENDERSON
Last Name:CHAMPAGNE
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 1:214 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2766
Mailing Address - Country:US
Mailing Address - Phone:601-508-0866
Mailing Address - Fax:
Practice Address - Street 1:214 HOLLY ST
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2766
Practice Address - Country:US
Practice Address - Phone:601-508-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203438363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner