Basic Information
Provider Information
NPI: 1417265836
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UNSEL
FirstName: LINDIE
MiddleName: LEE
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 23229
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423043229
CountryCode: US
TelephoneNumber: 2706881330
FaxNumber: 2706881338
Practice Location
Address1: 1301 PLEASANT VALLEY RD STE 404
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423039774
CountryCode: US
TelephoneNumber: 2704177515
FaxNumber: 2704177699
Other Information
ProviderEnumerationDate: 09/20/2010
LastUpdateDate: 11/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3006649KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
710013845005KY MEDICAID
20104093005IN MEDICAID


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