Provider Demographics
NPI:1659871358
Name:LUCAS, TAYLOR PAIGE (LVN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 NEELY DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-5743
Mailing Address - Country:US
Mailing Address - Phone:903-245-6849
Mailing Address - Fax:
Practice Address - Street 1:21321 NEELY DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-5743
Practice Address - Country:US
Practice Address - Phone:903-245-6849
Practice Address - Fax:903-245-6849
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341324164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse