Provider Demographics
NPI:1881019206
Name:POYTHRESS, LINDSEY (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:POYTHRESS
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 1:1473 NC 42 43 W
Mailing Address - Street 2:
Mailing Address - City:PINETOPS
Mailing Address - State:NC
Mailing Address - Zip Code:27864-7188
Mailing Address - Country:US
Mailing Address - Phone:252-827-5231
Mailing Address - Fax:
Practice Address - Street 1:1473 NC 42 43 W
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27864-7188
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4941363A00000X
NC0010-04856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6409PAMedicaid
SCSCQ8816067OtherMEDICARE PIN
SCSCQ8816084OtherMEDICARE PIN
SCSCQ881J577OtherMEDICARE PIN