Provider Demographics
NPI:1073170411
Name:LESTER, TRUDIAN ALICIA (FNP)
Entity Type:Individual
Prefix:
First Name:TRUDIAN
Middle Name:ALICIA
Last Name:LESTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 E HIGHWAY 191 STE 104
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8614
Mailing Address - Country:US
Mailing Address - Phone:432-640-6476
Mailing Address - Fax:432-640-4758
Practice Address - Street 1:8050 E HIGHWAY 191 STE 104
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8614
Practice Address - Country:US
Practice Address - Phone:432-640-6476
Practice Address - Fax:432-640-4758
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF11180211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403612102Medicaid