Provider Demographics
NPI:1265261895
Name:JESSIE, LINDSEY CHARLENE (NP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:CHARLENE
Last Name:JESSIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:CHARLENE
Other - Last Name:DERRICKSON-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15830 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:IN
Mailing Address - Zip Code:47357-9716
Mailing Address - Country:US
Mailing Address - Phone:765-527-7583
Mailing Address - Fax:
Practice Address - Street 1:15830 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:IN
Practice Address - Zip Code:47357-9716
Practice Address - Country:US
Practice Address - Phone:765-527-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28174392A363LF0000X
IN71016162A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily