Provider Demographics
NPI:1134411507
Name:PENNINGTON, LINDSEY ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ALEXANDER
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:OTOLARYNGOLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-813-2690
Mailing Address - Fax:318-813-2692
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:OTOLARYNGOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2690
Practice Address - Fax:318-813-2692
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205826207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2144464Medicaid
LA2144464Medicaid