Lidia Timofeenko Petersen

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

835379 Issued in NV

Practice address

972 Sugar Springs Dr
Las Vegas, NV 89110-2936

Phone

(208) 410-3048

NPI assigned

Jun 29, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, NV2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of NevadaGroup PAC ID 9234022153, 57 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ely, NV
  • NPI 1760572010
  Medicare reassignment Care Compare group NPD
• Southern Nevada Adult Mental Health

  • Adult Mental Health Clinic/Center
  • Las Vegas, NV
  • NPI 1891756920
  NPD
• State of Nevada

  • Skilled Nursing Facility
  • Boulder City, NV
  • NPI 1083612741
  NPD
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  NPD

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1245857952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 SUGAR SPRINGS DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891102936",
            "telephone_number": "208-410-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "972 SUGAR SPRINGS DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891102936",
            "telephone_number": "208-410-3048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMOFEENKO PETERSEN",
        "first_name": "LIDIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "53260",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "TEMP53260",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "835379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pammy Lshea Timmons
• Renetha Timmons
• Tamya Timmons
• Tanya Timmons
• Nicole Leann Timms, NP
• Timothy Ho DMD, Inc
• Timothy J Ladner MD Professional Corporation
• Timothy M. Tolan, M.D., Inc.
• Timothy P. Reardon D.D.S., M.S.
• Timothy T Sauter, MD LTD

• Psychiatric/Mental Health Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.