=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710700034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA ESTELLE OSTERMAN AGACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5125 TEXOMA MEDICAL CENTER DR STE 100
-----------------------------------------------------
City | DENISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75020-0084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-868-4700
-----------------------------------------------------
Fax | 903-892-4910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911230
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75391-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-997-8000
-----------------------------------------------------
Fax | 972-234-0813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1170305
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 1170305
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------