Provider Demographics
NPI:1093906265
Name:MABRY, LUCINDA (NP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 RICHLAND WEST CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7934
Mailing Address - Country:US
Mailing Address - Phone:254-772-5454
Mailing Address - Fax:254-772-6464
Practice Address - Street 1:300 RICHLAND WEST CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7934
Practice Address - Country:US
Practice Address - Phone:254-772-5454
Practice Address - Fax:254-772-6464
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX238321363LW0102X, 363LX0001X
TX889367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology