Provider Demographics
NPI:1710065834
Name:FERRINGTON, LINDSAY STAFFORD (PA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:STAFFORD
Last Name:FERRINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:UROLOGY DEPARTMENT
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71132-3932
Mailing Address - Country:US
Mailing Address - Phone:318-813-2775
Mailing Address - Fax:318-813-2755
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:UROLOGY DEPARTMENT
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130-3932
Practice Address - Country:US
Practice Address - Phone:318-813-2775
Practice Address - Fax:318-813-2755
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099295Medicaid