Provider Demographics
NPI:1710994306
Name:LINDSEY, SHIRLEY B (FNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:B
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 SOUTHWICK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-3228
Mailing Address - Country:US
Mailing Address - Phone:662-342-1409
Mailing Address - Fax:
Practice Address - Street 1:381 SOUTHWICK DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-3228
Practice Address - Country:US
Practice Address - Phone:662-342-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR359114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3631275Medicaid
TN3631275Medicare ID - Type UnspecifiedMEDICARE TN
P62672Medicare UPIN