Basic Information
| Provider Information | |||||||||
| NPI: | 1861689879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDESMA | ||||||||
| FirstName: | LUCY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844575 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566305522 | ||||||||
| FaxNumber: | 9569264352 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E RIDGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566305522 | ||||||||
| FaxNumber: | 9569264352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP111795 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 513804 | TX | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1982779-02 | 05 | TX | MEDICAID | 8749NA | 01 | TX | BCBS TX | OTHER |