Basic Information
| Provider Information | |||||||||
| NPI: | 1629480751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRESS | ||||||||
| FirstName: | LYNDSI | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3418 CASEY ST | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437567885 | ||||||||
| FaxNumber: | 8437567855 | ||||||||
| Practice Location | |||||||||
| Address1: | 3418 CASEY ST | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437567885 | ||||||||
| FaxNumber: | 8437567855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 83007 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.