Provider Demographics
NPI:1225277106
Name:MITCHELL, LACIE DYANNE (PA)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:DYANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1906 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6893
Mailing Address - Country:US
Mailing Address - Phone:903-892-8398
Mailing Address - Fax:903-892-7909
Practice Address - Street 1:1906 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6893
Practice Address - Country:US
Practice Address - Phone:903-892-8398
Practice Address - Fax:903-892-7909
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2013-09-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12518Medicare PIN