Provider Demographics
NPI:1902205883
Name:WHITE, LINDSEY DICUS (NP-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DICUS
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:DICUS
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:508 HARLEY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4294
Mailing Address - Country:US
Mailing Address - Phone:256-575-9044
Mailing Address - Fax:
Practice Address - Street 1:508 HARLEY ST
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4294
Practice Address - Country:US
Practice Address - Phone:256-575-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121648363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-121648OtherCRNP
AL1-121648OtherREGISTERED NURSE