Provider Demographics
NPI:1912503160
Name:LOPEZ, LUCAS LEOS (FNP-C)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:LEOS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 CACTUS DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6316
Mailing Address - Country:US
Mailing Address - Phone:432-816-2372
Mailing Address - Fax:
Practice Address - Street 1:1208 W HENDERSON ST STE A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-8773
Practice Address - Country:US
Practice Address - Phone:682-317-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty