Provider Demographics
NPI:1073849238
Name:SNOW, LISA DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1901 MEDI PARK DR
Mailing Address - Street 2:BLDG D SUITE 2051
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:806-359-0718
Mailing Address - Fax:806-359-9613
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:BLDG D SUITE 2051
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-359-0718
Practice Address - Fax:806-359-9613
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPENDING- TEMPORARY363AM0700X
TXPENDING - TEMPORARY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical