Provider Demographics
NPI:1659143386
Name:YI, NIDYA LOPEZ (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:NIDYA
Middle Name:LOPEZ
Last Name:YI
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY STE 365
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5890
Mailing Address - Country:US
Mailing Address - Phone:713-400-6325
Mailing Address - Fax:
Practice Address - Street 1:21212 NORTHWEST FWY STE 365
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5890
Practice Address - Country:US
Practice Address - Phone:134-006-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141732363LA2100X
TX823360163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine