Provider Demographics
NPI:1346323136
Name:LUCAS, CHRISTY L (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:L
Other - Last Name:GAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:597 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:WV
Mailing Address - Zip Code:26451-6801
Mailing Address - Country:US
Mailing Address - Phone:304-745-4568
Mailing Address - Fax:304-326-3700
Practice Address - Street 1:597 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:WV
Practice Address - Zip Code:26451-6801
Practice Address - Country:US
Practice Address - Phone:304-745-4568
Practice Address - Fax:304-326-3700
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01085363AM0700X
WV661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00466815OtherRAILROAD MEDICARE
WV3810010826Medicaid
Q53558Medicare UPIN
WVGAPA25641Medicare ID - Type Unspecified