Provider Demographics
NPI:1740719491
Name:RUNNELS, LINDSAY (CSA, STFA)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:CSA, STFA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:500 EASTSIDE CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7793
Mailing Address - Country:US
Mailing Address - Phone:601-842-7355
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY STE 27202
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:769-300-2946
Practice Address - Fax:769-300-2953
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4681246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant