Healthcare Provider Details

I. General information

NPI: 1528044161
Provider Name (Legal Business Name): TINA M. LAWSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA WALLS LAWSON M.D.

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 WESTFIELD BLVD STE 200
WESTFIELD IN
46074-1437
US

IV. Provider business mailing address

2330 S DIXON RD
KOKOMO IN
46902-6434
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-9200
  • Fax:
Mailing address:
  • Phone: 765-455-5400
  • Fax: 765-865-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01044162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: