Provider Demographics
NPI:1013631100
Name:GOTHAM, LINDSAY RUTH (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:RUTH
Last Name:GOTHAM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:RUTH
Other - Last Name:DRUMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:3707 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8921
Mailing Address - Country:US
Mailing Address - Phone:315-528-5588
Mailing Address - Fax:
Practice Address - Street 1:3707 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8921
Practice Address - Country:US
Practice Address - Phone:315-528-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY716441OtherNY RN
WV98273OtherWV RN
WV114368OtherFNP-C