Provider Demographics
NPI:1265184451
Name:GILLIGAN, LINDSAY (NP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:DAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2210 SUTHERLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2337
Mailing Address - Country:US
Mailing Address - Phone:865-525-4333
Mailing Address - Fax:
Practice Address - Street 1:2210 SUTHERLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-525-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265809363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ086812Medicaid