Lydia Gennie, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5214585 Issued in FL

Practice address

1004 Shoreline Dr
Bainbridge, GA 39817-8393

Phone

(850) 363-8735

NPI assigned

Aug 28, 2020

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 28, 2020.

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1689287641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 SHORELINE DR",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398178393",
            "telephone_number": "850-363-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 SHORELINE DR",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398178393",
            "telephone_number": "850-363-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENNIE",
        "first_name": "LYDIA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5214585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bainbridge, GA
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.