Provider Demographics
NPI:1780432005
Name:UPCHURCH, LINDSEY DURHAM PARKHURST
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DURHAM PARKHURST
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W TREMONT AVE UNIT 309
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5493
Mailing Address - Country:US
Mailing Address - Phone:704-975-9787
Mailing Address - Fax:
Practice Address - Street 1:125 W TREMONT AVE UNIT 309
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5493
Practice Address - Country:US
Practice Address - Phone:704-975-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program