Provider Demographics
NPI:1316503170
Name:LOVE, LINDSEY MAE (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MAE
Last Name:LOVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MAE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4221 S. WESTERN AVE #2010
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-2242
Mailing Address - Country:US
Mailing Address - Phone:405-644-5120
Mailing Address - Fax:405-644-5309
Practice Address - Street 1:4221 S WESTERN AVE STE 2010
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3445
Practice Address - Country:US
Practice Address - Phone:405-644-5120
Practice Address - Fax:405-644-5309
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant