Provider Demographics
NPI:1184904294
Name:PETERS, LINDSIE NICOLE
Entity type:Individual
Prefix:
First Name:LINDSIE
Middle Name:NICOLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PARK BEND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5386
Mailing Address - Country:US
Mailing Address - Phone:512-836-5665
Mailing Address - Fax:
Practice Address - Street 1:2200 PARK BEND DR BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-836-5665
Practice Address - Fax:512-997-9092
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX739626363LF0000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX276898TQJKOtherMEDICARE PTAN