Provider Demographics
NPI:1942759766
Name:STUBBS, LINDSEY TATUM (AGACNP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:TATUM
Last Name:STUBBS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:KATHERINE
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-1000
Mailing Address - Fax:601-815-1631
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-1000
Practice Address - Fax:601-815-1631
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS883204163WC0200X
MS901759363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04675362Medicaid
MS540435YJ5DMedicare PIN