LYDIA HELEN NEFEDOV MSN AGNP-BC NPI 1902349772

NPI Information

NPI: 1902349772
Provider Name: LYDIA HELEN NEFEDOV, MSN, AGNP-BC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
3463 MAGIC DR STE T21
SAN ANTONIO, TX
ZIP 78229
Phone: (210) 614-8101
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Lydia Helen Nefedov, MSN, AGNP-BC is a gerontology nurse practitioner in San Antonio, TX with 3 years of experience. Lydia Helen Nefedov, MSN, AGNP-BC NPI is 1902349772. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3463 MAGIC DR STE T21
SAN ANTONIO, TX
ZIP 78229-621
Phone: (210) 614-8101

The NPI 1902349772 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/28/2016 and was last updated on 8/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	1075580	TEXAS	No
2	363LG0600X	Nurse Practitioner	Gerontology	APRN002369	NEVADA	No
3	363LG0600X	Nurse Practitioner	Gerontology	71013911A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	090540884	OTHER	NEW JERSEY	MEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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