Provider Demographics
NPI:1528503117
Name:HAMMOND, MOLLY LANE (PA-C)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:LANE
Last Name:HAMMOND
Suffix:
Gender:F
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 1:7777 FOREST LN STE C300G
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6905
Mailing Address - Country:US
Mailing Address - Phone:972-566-5564
Mailing Address - Fax:972-566-3556
Practice Address - Street 1:7777 FOREST LN STE C300G
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6905
Practice Address - Country:US
Practice Address - Phone:972-566-5564
Practice Address - Fax:972-566-3556
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
TXPA11074363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant