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General NPI Number Information
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NPI Number | 1437357159
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Entity Type | Individual
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Provider Name | LUKISHA DOMALLY WILLETT P.A.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 155 LOUETTA CROSSING
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City | SPRING
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State | TX
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Zip | 77373
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Country | US
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Telephone | 281-528-0278
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Fax |
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Provider Business Mailing Address
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Address Line | 22311 E DANIEL OAK CIR
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City | SPRING
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State | TX
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Zip | 77389-4017
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Country | US
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Telephone | 281-323-3568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05258
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License Number State | TX
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