Provider Demographics
NPI:1801907621
Name:LYBBERT, ANGELA NAOMI (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NAOMI
Last Name:LYBBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9325 RAM CLIFFS PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3533
Mailing Address - Country:US
Mailing Address - Phone:702-278-9135
Mailing Address - Fax:888-384-5951
Practice Address - Street 1:4270 S DECATUR BLVD STE B5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6802
Practice Address - Country:US
Practice Address - Phone:725-220-4200
Practice Address - Fax:725-220-4199
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA685363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002402137Medicaid
NVNV1360OtherANTHEM BCBS NV GROUP
NVCC9894OtherANTHEM BCBS NV
NVV103699OtherNV MEDICARE PTAN
NV100510051Medicaid
NVV103699OtherNV MEDICARE PTAN
NV100510051Medicaid