Provider Demographics
NPI:1952772394
Name:PATRICK, LINDSEY NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:NICOLE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:NICOLE
Other - Last Name:TALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0540
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:402 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1238
Practice Address - Country:US
Practice Address - Phone:606-549-2656
Practice Address - Fax:606-549-2855
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22737363LF0000X
KY3009790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032064Medicaid
KY3009790OtherSTATE LICENSE
KY7100384390Medicaid
TN22737OtherSTATE LICENSE
TN22737OtherSTATE LICENSE