Healthcare Provider Details

I. General information

NPI: 1407223571
Provider Name (Legal Business Name): LINDSEY M TABOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY M TOLLEY FNP

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 MILLER MOUNTAIN DR
WEBSTER SPRINGS WV
26288-1065
US

IV. Provider business mailing address

324 MILLER MOUNTAIN DR
WEBSTER SPRINGS WV
26288-1065
US

V. Phone/Fax

Practice location:
  • Phone: 304-847-5682
  • Fax: 304-847-5985
Mailing address:
  • Phone: 304-847-5682
  • Fax: 304-847-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number136
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number136
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69001
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: