MEDICARE: HYLDA BENNETT NUGENT CRNA, DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	539244	TX
2	367500000X	Certified Registered Nurse Anesthetist	AP108763	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85450U	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316924517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYLDA BENNETT NUGENT CRNA, DNP

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	469-291-3369
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD STOP 7200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-6524
Country	:	US
Telephone Number	:	214-648-6400
Fax Number	:	214-648-5461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/15/2021

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