Healthcare Provider Details

I. General information

NPI: 1245948793
Provider Name (Legal Business Name): LINDSAY NICOLE ARCHIQUETTE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY NICOLE GOLDTHORPE RD

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 BRIGHTON PARK WAY
MADISON AL
35756-4937
US

IV. Provider business mailing address

254 BRIGHTON PARK WAY
MADISON AL
35756-4937
US

V. Phone/Fax

Practice location:
  • Phone: 315-408-6710
  • Fax:
Mailing address:
  • Phone: 315-408-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number355929
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3364
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86115574
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: