Healthcare Provider Details

I. General information

NPI: 1689595415
Provider Name (Legal Business Name): LYDIA ALANE ANDERSON DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E CHURCH ST STE B
CHERRYVILLE NC
28021-2968
US

IV. Provider business mailing address

910 E CHURCH ST STE B
CHERRYVILLE NC
28021-2968
US

V. Phone/Fax

Practice location:
  • Phone: 704-445-0422
  • Fax:
Mailing address:
  • Phone: 704-445-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32752
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number388139
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: