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Individual
LISA HICKS THOMPSON
Active
Individual
LISA HICKS THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001505A
IN
363A00000X
Physician Assistant
PA03855
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190024301
—
TX
05
—
190024302
—
TX
05
—
190024303
—
TX
05
—
300011148
—
IN
Enumeration date
10/10/2006
Last updated
10/19/2021
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