Provider Demographics
NPI:1952644742
Name:BULL, LINDSEY PRESLEY (DO)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:PRESLEY
Last Name:BULL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:KYLE
Other - Last Name:PRESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2221 JACKSBORO PIKE STE C4
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3007
Practice Address - Country:US
Practice Address - Phone:423-566-3488
Practice Address - Fax:866-722-3453
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2983208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022597Medicaid