Healthcare Provider Details

I. General information

NPI: 1316330608
Provider Name (Legal Business Name): LAUREN NICOLE KINDLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST STE C825
CHATTANOOGA TN
37403-3357
US

IV. Provider business mailing address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-4830
  • Fax: 423-778-4831
Mailing address:
  • Phone: 423-778-4830
  • Fax: 423-778-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2726
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: