Provider Demographics
NPI:1487642260
Name:LUCAS, CAROL O (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:O
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:8408 TYHURST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3522
Mailing Address - Country:US
Mailing Address - Phone:512-751-0753
Mailing Address - Fax:
Practice Address - Street 1:3201 HIGHWAY 71 E
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5126
Practice Address - Country:US
Practice Address - Phone:512-751-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518261367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100878100OtherFIRSTCARE
TX00C59ROtherBLUE CROSS BLUE SHIELD
TX742929703OtherHUMANA/MILITARY
TX152275701Medicaid
TX100878100OtherFIRSTCARE
TX00C59ROtherBLUE CROSS BLUE SHIELD