Provider Demographics
NPI:1154705689
Name:ALLEN, LINDSY LAURA KRAGT (DPM)
Entity type:Individual
Prefix:
First Name:LINDSY
Middle Name:LAURA KRAGT
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LINDSY
Other - Middle Name:LAURA
Other - Last Name:KRAGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:575 RIVERGATE UNIT 105
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7490
Mailing Address - Country:US
Mailing Address - Phone:303-717-7346
Mailing Address - Fax:
Practice Address - Street 1:1608 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-395-9575
Practice Address - Fax:505-466-5166
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPOD413213ES0103X
PASC006691213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery