Provider Demographics
NPI:1457861478
Name:BIRCH, LINDSAY REBECCA (MSN, ACNPC-AG, NP-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:REBECCA
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MSN, ACNPC-AG, NP-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:REBECCA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:901-478-9183
Mailing Address - Fax:901-478-8993
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-478-9183
Practice Address - Fax:901-478-8993
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902151363LA2100X
TN25023363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6191130OtherBCBS
MS01786701Medicaid
AR234220758Medicaid
TNQ048360Medicaid