Provider Demographics
NPI:1720401334
Name:LANDERS, LINDSEY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:DANIELLE
Other - Last Name:CAUDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1084 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-9602
Mailing Address - Country:US
Mailing Address - Phone:270-237-3123
Mailing Address - Fax:270-237-3139
Practice Address - Street 1:1084 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-9602
Practice Address - Country:US
Practice Address - Phone:270-237-3123
Practice Address - Fax:270-237-3139
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100289960Medicaid