Provider Demographics
NPI:1376208249
Name:LORREN, ALISHA RENAY (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:RENAY
Last Name:LORREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 COUNTY ROAD 4328
Mailing Address - Street 2:
Mailing Address - City:LARUE
Mailing Address - State:TX
Mailing Address - Zip Code:75770-4375
Mailing Address - Country:US
Mailing Address - Phone:903-571-9082
Mailing Address - Fax:
Practice Address - Street 1:1005 LEGACY RANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1294
Practice Address - Country:US
Practice Address - Phone:903-571-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15129363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty