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General NPI Number Information
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NPI Number | 1851128326
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Entity Type | Individual
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Provider Name | LYDIA ROSE JARKA PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | US HIGHWAY 84 COUNTY ROAD 0324 #14
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575
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Country | US
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Telephone | 575-588-7252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575-0250
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Country | US
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Telephone | 575-588-7252
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Fax | 575-756-2821
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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