Provider Demographics
NPI:1114377611
Name:CARDENAS, LOURDES ERICA (APRN)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:ERICA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 HILLCREST DR
Mailing Address - Street 2:STE A
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3165
Mailing Address - Country:US
Mailing Address - Phone:940-552-5495
Mailing Address - Fax:940-552-2473
Practice Address - Street 1:1015 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3100
Practice Address - Country:US
Practice Address - Phone:940-473-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130985363L00000X, 363LA2200X, 363LG0600X
TXAG0416007 AANCP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology