Healthcare Provider Details

I. General information

NPI: 1780982801
Provider Name (Legal Business Name): LYDIA GIKERE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 N COLLINS BLVD STE 607
RICHARDSON TX
75080-2636
US

IV. Provider business mailing address

PO BOX 914
LEHI UT
84043-1189
US

V. Phone/Fax

Practice location:
  • Phone: 800-640-3451
  • Fax:
Mailing address:
  • Phone: 800-640-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP119949
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP119949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: