Individual provider Active NPI

Lydia C Warner, FNP-BC

  • Family Nurse Practitioner
  • Beaverton, OR
National Provider Identifier
1225314792
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201250017NP Issued in OR
Practice address
1500 NW Bethany Blvd Ste 200
Beaverton, OR 97006-5236
Phone
(503) 708-0523
Fax
(844) 813-1588
NPI assigned
Oct 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X N360257589 WA
Family Nurse Practitioner 363LF0000X SP011437 PA
Family Nurse Practitioner 363LF0000X 201250017NP OR Primary

Addresses

Primary practice location

1500 NW Bethany Blvd Ste 200
Beaverton, OR 97006-5236

Mailing address

PO Box 239
Astoria, OR 97103-0239
Phone (503) 325-8315

Other identifiers 1

IdentifierTypeStateIssuer
231893MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121121000016 OR Practitioner - Nurse Practitioner 7719138734

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SP011437PAMDFamily Nurse Practitioner
N360257589WAMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225314792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 239",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971030239",
            "telephone_number": "503-325-8315",
            "fax_number": "503-325-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 NW BETHANY BLVD STE 200",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065236",
            "telephone_number": "503-708-0523",
            "fax_number": "844-813-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARNER",
        "first_name": "LYDIA",
        "middle_name": "C",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "N360257589",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP011437",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201250017NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231893",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.