Healthcare Provider Details

I. General information

NPI: 1184904294
Provider Name (Legal Business Name): LINDSIE NICOLE PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 2
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

2200 PARK BEND DR STE 300
AUSTIN TX
78758-5386
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-5665
  • Fax: 512-997-9092
Mailing address:
  • Phone: 512-836-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number739626
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: