Basic Information
Provider Information
NPI: 1255873899
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: LYNDSY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2620 ELM HILL PIKE
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372143108
CountryCode: US
TelephoneNumber: 6154254200
FaxNumber:  
Practice Location
Address1: 1045 HILL RD N
Address2:  
City: PICKERINGTON
State: OH
PostalCode: 431478666
CountryCode: US
TelephoneNumber: 6154254200
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/14/2016
LastUpdateDate: 12/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN353418OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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