Provider Demographics
NPI:1427127109
Name:EXLINE, LINDSAY K (PAC)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:K
Last Name:EXLINE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:K
Other - Last Name:WATERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:12200 WEBER HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1569
Mailing Address - Country:US
Mailing Address - Phone:314-842-5660
Mailing Address - Fax:314-842-0169
Practice Address - Street 1:12200 WEBER HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1569
Practice Address - Country:US
Practice Address - Phone:314-842-5660
Practice Address - Fax:314-842-0169
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010004021363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA177920Medicaid
CAQ40306Medicare UPIN
CAOPA177920Medicare ID - Type Unspecified