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NPI Code Detail

MEDICARE: ANGELA NAOMI LYBBERT PA-C

MEDICARE: ANGELA NAOMI LYBBERT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA685NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4V103699OTHERNVNV MEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NV1360OTHERNVANTHEM BCBS NV GROUP
3CC9894OTHERNVANTHEM BCBS NV
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801907621
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA NAOMI LYBBERT PA-C
Provider Business Mailing Address
First Line : 9325 RAM CLIFFS PL
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-3533
Country : US
Telephone Number : 702-278-9135
Fax Number : 888-384-5951
Provider Business Practice Location Address
First Line : 4270 S DECATUR BLVD STE B5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-6802
Country : US
Telephone Number : 725-220-4200
Fax Number : 725-220-4199
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 05/06/2020

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Directions to “ ANGELA NAOMI LYBBERT PA-C” Practice Location

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