Provider Demographics
NPI:1033632112
Name:RAMOS, LYDIA KYMBERLIE SPARKS (PA-C)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:KYMBERLIE SPARKS
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4201
Mailing Address - Country:US
Mailing Address - Phone:919-594-2775
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4201
Practice Address - Country:US
Practice Address - Phone:919-594-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08993363A00000X
CA545102084P0800X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry