Provider Demographics
NPI:1952414591
Name:LINDSEY, TERRY F (PA)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:F
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CLINTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2678
Mailing Address - Country:US
Mailing Address - Phone:209-223-4994
Mailing Address - Fax:209-223-1952
Practice Address - Street 1:201 CLINTON RD STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2678
Practice Address - Country:US
Practice Address - Phone:209-223-4994
Practice Address - Fax:209-223-1952
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS15997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA135851Medicare ID - Type Unspecified
CAS15997Medicare UPIN