Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 06005 | TX |
NPI | 1053437343 |
---|---|
Provider Name | Lisa Kay Thomas |
First Address | Grand Prairie, TX 75050-5545 |
Second Address | Grand Prairie, TX 75050-5545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |