MRS. LINDSEY LEANN SAMPLE MSN, AG-ACNP
Complete NPI Record 1114588076
Nurse Practitioner in Valparaiso, IN
Active since June 21, 2019PECOS EnrolledAccepts Medicare Assignment
87.95/100
CMS Quality Rating
Complete NPI Dataset
This page contains the complete raw NPPES record for Mrs. Lindsey Leann Sample, MSN, AG-ACNP (NPI 1114588076), an individual nurse practitioner provider in Valparaiso, IN. All 38 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1114588076 Field 1/38
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/38
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: SAMPLE Field 3/38
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: LINDSEY Field 4/38
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: LEANN Field 5/38
- The middle name of the provider, if the provider is an individual.
- Provider Name Prefix Text: MRS. Field 6/38
- The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
- Provider Credential Text: MSN, AG-ACNP Field 7/38
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 2022 KELLE DR Field 8/38
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: CHESTERTON Field 9/38
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IN Field 10/38
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 463048708 Field 11/38
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 12/38
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 2193643616 Field 13/38
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 2193643610 Field 14/38
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 1101 GLENDALE BLVD STE 103 Field 15/38
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: VALPARAISO Field 16/38
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IN Field 17/38
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 463833769 Field 18/38
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 19/38
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2194649054 Field 20/38
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 2194651749 Field 21/38
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 24/38
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 163W00000X Field 25/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 041437122 Field 26/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: IL Field 27/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 163W00000X Field 29/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: 28215273A Field 30/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: IN Field 31/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 32/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 363L00000X Field 33/38
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 3: 71009567A Field 34/38
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 3: IN Field 35/38
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 3: Y Field 36/38
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 37/38
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 5
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
3630 Willowcreek Rd
Location 1/5Portage, IN 46368-5075 · Phone (219) 464-9054 · Fax (219) 465-1749
813 Porter Campus Dr Ste ABC
Location 2/5Valparaiso, IN 46383-0089 · Phone (219) 464-9054 · Fax (219) 464-9054
85 E US Highway 6
Location 3/5Valparaiso, IN 46383-8947 · Phone (219) 464-9054 · Fax (219) 465-1749
85 E US Highway 6 Ste 235
Location 4/5Valparaiso, IN 46383-8948 · Phone (219) 464-9054 · Fax (219) 465-1749
85 E US Highway 6 Ste 210
Location 5/5Valparaiso, IN 46383-8954 · Phone (219) 464-9054 · Fax (219) 465-1749
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