Basic Information
Provider Information
NPI: 1053052340
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEFTWICH-PAQUETTE
FirstName: LYNDSAY
MiddleName: GAYLE
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3405 CREEKBEND DR
Address2:  
City: GARLAND
State: TX
PostalCode: 750442025
CountryCode: US
TelephoneNumber: 2175215106
FaxNumber:  
Practice Location
Address1: 3500 W WHEATLAND RD
Address2:  
City: DALLAS
State: TX
PostalCode: 752373460
CountryCode: US
TelephoneNumber: 2149605681
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/02/2022
LastUpdateDate: 04/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X1074228TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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