Healthcare Provider Details

I. General information

NPI: 1881669620
Provider Name (Legal Business Name): CAROL LINDSEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

1493 WILLOW BEND CT
CLARKSVILLE TN
37043-1764
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8671
  • Fax:
Mailing address:
  • Phone: 931-905-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88218
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number6564
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: