Provider Demographics
NPI:1275316226
Name:LYDON, SABRINA LOU (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:LOU
Last Name:LYDON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BREMOND
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4893
Mailing Address - Country:US
Mailing Address - Phone:254-423-5035
Mailing Address - Fax:
Practice Address - Street 1:2300 CLEAR CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5404
Practice Address - Country:US
Practice Address - Phone:254-781-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11111479363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health