Provider Demographics
NPI:1336531672
Name:DILL, LYNDSEY (NP)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:DILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:THIGPEN
Other - Last Name:DILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
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:601-984-5610
Mailing Address - Fax:601-984-5783
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:601-984-5610
Practice Address - Fax:601-984-5783
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889051363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08259244Medicaid