Provider Demographics
NPI:1790700680
Name:COOVER, LILLIAN M (PA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:M
Last Name:COOVER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2046 FOREST LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7958
Mailing Address - Country:US
Mailing Address - Phone:972-494-4494
Mailing Address - Fax:972-494-4450
Practice Address - Street 1:3228 I-30
Practice Address - Street 2:SUITE 200
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2633
Practice Address - Country:US
Practice Address - Phone:972-216-5400
Practice Address - Fax:972-216-5405
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-01-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182461701Medicaid
TX87N961Medicare ID - Type Unspecified
TX182461701Medicaid