Provider Demographics
NPI:1932760782
Name:LUNDQUIST, LINDSEY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3056
Mailing Address - Country:US
Mailing Address - Phone:865-679-4415
Mailing Address - Fax:
Practice Address - Street 1:2707 JACKSBORO PIKE STE 2
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2752
Practice Address - Country:US
Practice Address - Phone:423-437-8576
Practice Address - Fax:423-437-8556
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013504363LF0000X
TN26022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053005Medicaid