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General NPI Number Information
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NPI Number | 1235625963
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Entity Type | Individual
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Provider Name | LYDIA SOPHIA CROWDER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3 AUDUBON PLAZA DR STE 220
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City | LOUISVILLE
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State | KY
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Zip | 40217
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Country | US
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Telephone | 502-636-7242
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Fax | 502-636-7130
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 3012245
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3012245
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License Number State | KY
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