Provider Demographics
NPI:1235625963
Name:CROWDER, LYDIA SOPHIA (APRN)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:SOPHIA
Last Name:CROWDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 220
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-636-7242
Practice Address - Fax:502-636-7130
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012245363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYMM5625225OtherDEA