Provider Demographics
NPI:1780279968
Name:HERNANDEZ, LINDSAY CHARISSE
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:CHARISSE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1137
Mailing Address - Country:US
Mailing Address - Phone:405-410-8405
Mailing Address - Fax:
Practice Address - Street 1:602 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-2020
Practice Address - Country:US
Practice Address - Phone:405-827-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator