Basic Information
| Provider Information | |||||||||
| NPI: | 1447848858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANOVER | ||||||||
| FirstName: | LINSEY | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ESTILL SPRINGS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373304037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882914357 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 416 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ESTILL SPRINGS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373304037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882914357 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2021 | ||||||||
| LastUpdateDate: | 01/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | 1121 | TN | Y |
ID Information
| ID | Type | State | Issuer | Description | UNKNOWN | 05 | TN | MEDICAID | UNKNOWN | 01 | TN | INSURANCE | OTHER |