Healthcare Provider Details

I. General information

NPI: 1902314693
Provider Name (Legal Business Name): SARAH LINDSEY ABDEEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 1460
JACKSON MS
39216-4621
US

IV. Provider business mailing address

971 LAKELAND DR STE 1460
JACKSON MS
39216-4621
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-3202
  • Fax: 601-982-3259
Mailing address:
  • Phone: 601-982-3202
  • Fax: 601-982-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: