Healthcare Provider Details

I. General information

NPI: 1366061343
Provider Name (Legal Business Name): LINDSAY HERNDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 GREEN ACRES RD STE 101
FORT WALTON BEACH FL
32547-1170
US

IV. Provider business mailing address

319 GREEN ACRES RD STE 101
FORT WALTON BEACH FL
32547-1170
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-7681
  • Fax:
Mailing address:
  • Phone: 850-243-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME162645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: