Provider Demographics
NPI:1851852388
Name:CASEY, LYDIA BALMOS (RN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:BALMOS
Last Name:CASEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:KELLER
Other - Last Name:BALMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1802 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1932
Mailing Address - Country:US
Mailing Address - Phone:513-205-1663
Mailing Address - Fax:
Practice Address - Street 1:1802 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1932
Practice Address - Country:US
Practice Address - Phone:513-205-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily