Provider Demographics
NPI:1588962773
Name:FRIEDEL, LYNDSIE (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:
Last Name:FRIEDEL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-240-8985
Mailing Address - Fax:702-304-4013
Practice Address - Street 1:4750 W OAKEY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1535
Practice Address - Country:US
Practice Address - Phone:702-877-8330
Practice Address - Fax:702-259-0128
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07164363A00000X, 363AS0400X
NVPA0309363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281537503Medicaid
TXP01031520OtherRAILROAD MEDICARE
NV1588962773Medicaid
TX866N76OtherBCBS
TXP01031520OtherRAILROAD MEDICARE
TX281537503Medicaid