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Individual
ALLISON LOCK
Active
Individual
ALLISON LOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09554
TX
363AS0400X
Surgical Physician Assistant
PA.0005399
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
342049902
—
TX
01
—
342049903
MEDICAID CSHCN
TX
Enumeration date
09/30/2014
Last updated
05/28/2021
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