Provider Demographics
NPI:1245948793
Name:ARCHIQUETTE, LINDSAY NICOLE (RD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICOLE
Last Name:ARCHIQUETTE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:GOLDTHORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:254 BRIGHTON PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4937
Mailing Address - Country:US
Mailing Address - Phone:315-408-6710
Mailing Address - Fax:
Practice Address - Street 1:254 BRIGHTON PARK WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-4937
Practice Address - Country:US
Practice Address - Phone:315-408-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI355929133V00000X
AL3364133V00000X
86115574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered