Provider Demographics
NPI:1861631764
Name:MANGUM, LINDSEY HALL (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:HALL
Last Name:MANGUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 HELTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1069
Mailing Address - Country:US
Mailing Address - Phone:256-980-6214
Mailing Address - Fax:256-284-7264
Practice Address - Street 1:2129 HELTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1069
Practice Address - Country:US
Practice Address - Phone:256-980-6214
Practice Address - Fax:256-284-7264
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1703363AM0700X
AL1142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522323Medicaid
AL209151Medicaid