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NPI Code Detail

MEDICARE: BETHANY M. LUCAS PA

MEDICARE: BETHANY M. LUCAS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA05955TX
2363A00000XPhysician Assistant12533MN
3363AM0700XMedical Physician AssistantPA05955TX
4363AS0400XSurgical Physician AssistantPA05955TX

General Provider Information

NPI Number : 1225283963
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY M. LUCAS PA
Provider Business Mailing Address
First Line : 5615 DEAUVILLE STE 220
Second Line :
City : MIDLAND
State : TX
Zip : 79706-2707
Country : US
Telephone Number : 325-226-3503
Fax Number :
Provider Business Practice Location Address
First Line : 5615 DEAUVILLE STE 220
Second Line :
City : MIDLAND
State : TX
Zip : 79706-2707
Country : US
Telephone Number : 432-221-4755
Fax Number : 432-686-0664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2008
Last Update Date : 11/07/2024

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Directions to “ BETHANY M. LUCAS PA” Practice Location

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