Provider Demographics
NPI:1649660481
Name:LYALL, LINDSAY YOUNT (PA)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:YOUNT
Last Name:LYALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:CLAIRE
Other - Last Name:YOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-1331
Mailing Address - Fax:
Practice Address - Street 1:151 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9560
Practice Address - Country:US
Practice Address - Phone:336-246-7161
Practice Address - Fax:336-246-6183
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant