Provider Demographics
NPI:1174963854
Name:CLARKE, LINDSAY DRIVER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:DRIVER
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:GAYLE
Other - Last Name:DRIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7200 CREEDMOOR ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:919-518-0999
Mailing Address - Fax:919-518-0939
Practice Address - Street 1:7200 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-518-0999
Practice Address - Fax:919-518-0939
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCK59D804Medicaid