Provider Demographics
NPI:1427717305
Name:LUCAS, ALEXIS ANN (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12703 S 75TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-1501
Mailing Address - Country:US
Mailing Address - Phone:918-606-2146
Mailing Address - Fax:
Practice Address - Street 1:3636 EXECUTIVE CENTER DR STE G70
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1628
Practice Address - Country:US
Practice Address - Phone:512-371-9555
Practice Address - Fax:512-367-5756
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA15472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX737791OtherTEXAS MEDICAL BOARD ID