Provider Demographics
NPI:1346082807
Name:LORDS, COLTON JESSE (PA-C)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:JESSE
Last Name:LORDS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:141 VALLEY VIEW DR APT 1904
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7792
Mailing Address - Country:US
Mailing Address - Phone:801-367-1675
Mailing Address - Fax:
Practice Address - Street 1:5203 LAKE RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3010
Practice Address - Country:US
Practice Address - Phone:682-218-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant