Provider Demographics
NPI:1861689879
Name:LEDESMA, LUCY T (APRN)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:T
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844575
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4575
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-926-4352
Practice Address - Street 1:500 E RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1506
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-926-4352
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111795363L00000X
TX513804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982779-02Medicaid
TX8749NAOtherBCBS TX
TX275707YN0EMedicare PIN