Basic Information
Provider Information
NPI: 1922453190
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDSEY
FirstName: RACHEL
MiddleName: MICHELLE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: PO BOX 699
Address2:  
City: MOUNTAIN HOME
State: TN
PostalCode: 376840699
CountryCode: US
TelephoneNumber: 4234336039
FaxNumber: 4234336060
Practice Location
Address1: 325 N STATE OF FRANKLIN RD, GROUND FLOOR
Address2: ETSU PHYSICIANS AND ASSOCIATES PEDIATRICS
City: JOHNSON CITY
State: TN
PostalCode: 376046056
CountryCode: US
TelephoneNumber: 4234397320
FaxNumber: 4234397343
Other Information
ProviderEnumerationDate: 04/25/2016
LastUpdateDate: 06/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X0101266890VAN Allopathic & Osteopathic PhysiciansPediatrics 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208000000X59213TNY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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