Healthcare Provider Details

I. General information

NPI: 1538697453
Provider Name (Legal Business Name): TREVALLA KAYE LINDSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TREVALLA KAYE LINDSEY FNP-C

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 WINTER ST
JACKSON MS
39204-2841
US

IV. Provider business mailing address

108 HIDDEN HILLS DR
MADISON MS
39110-8800
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-5572
  • Fax: 601-353-7070
Mailing address:
  • Phone: 601-421-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902030
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: