Marcia Kay Lidtke, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9836853-4405 Issued in UT

Practice address

750 N Freedom Blvd
Provo, UT 84601-1677

Phone

(801) 373-9656

Fax

(801) 373-2978

NPI assigned

May 8, 2007

Last updated

Jan 19, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wasatch Behavioral Health Special Service DistrictGroup PAC ID 2567367915, 84 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wasatch Behavioral Health Special Service District

  • Community/Behavioral Health Agency
  • Provo, UT
  • NPI 1356357115
  Medicare reassignment Care Compare group NPD
• Wasatch Behavioral Health Special Service District

  • Clinical Medical Laboratory
  • Orem, UT
  • NPI 1669257556
  NPD

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1972716496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 E EMERALD CT",
            "city": "SARATOGA SPRINGS",
            "state": "UT",
            "postal_code": "840458141",
            "telephone_number": "408-813-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011677",
            "telephone_number": "801-373-9656",
            "fax_number": "801-373-2978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDTKE",
        "first_name": "MARCIA",
        "middle_name": "KAY",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "9836853-4405",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "13626",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Lewis
• Micaela Lewis
• Todd J Lewis, OD
• Tao Li, MD
• Liberty Horizon Inc (HealthSource of North Provo)
• Allison Liechty, SSW
• Louise Lierman
• Life Enhancement Center
• Life Enhancement Center
• Life Family Matters LLC

• Family Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; 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.