Provider Demographics
NPI:1932920717
Name:BEARDEN, LINDSEY (RN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 VALLEY FORGE RD APT E
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6932
Mailing Address - Country:US
Mailing Address - Phone:256-694-9238
Mailing Address - Fax:
Practice Address - Street 1:4121 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6262
Practice Address - Country:US
Practice Address - Phone:618-242-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-197419163W00000X
IL041.556846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse