Healthcare Provider Details

I. General information

NPI: 1619236981
Provider Name (Legal Business Name): LINDSEY WILSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 W SUNSET AVE STE 157
SPRINGDALE AR
72762-4410
US

IV. Provider business mailing address

5320 W SUNSET AVE STE 157
SPRINGDALE AR
72762-4410
US

V. Phone/Fax

Practice location:
  • Phone: 479-966-7331
  • Fax: 479-408-4285
Mailing address:
  • Phone: 479-966-7331
  • Fax: 479-408-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-483
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: