Provider Demographics
NPI:1962591024
Name:LUCAS, ASHLEA MICA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEA
Middle Name:MICA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ASHLEA
Other - Middle Name:MICA
Other - Last Name:HARPOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:512-495-5300
Mailing Address - Fax:
Practice Address - Street 1:4544 S LAMAR BLVD STE 760
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-433-6333
Practice Address - Fax:512-433-6331
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant