Healthcare Provider Details

I. General information

NPI: 1811661861
Provider Name (Legal Business Name): TONYA MISCHELL LUCAS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 W AIRPORT FWY STE 3313
IRVING TX
75062-5937
US

IV. Provider business mailing address

14100 SAN PEDRO AVE STE 608
SAN ANTONIO TX
78232-4363
US

V. Phone/Fax

Practice location:
  • Phone: 214-292-6093
  • Fax:
Mailing address:
  • Phone: 210-846-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1184850
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021015302
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: