Individual
MRS. MICAH DANIELLE LUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5004 122ND ST STE 200, LUBBOCK, TX 79424-8398
(469) 734-8689
Mailing address
7008 INDIANA AVE, STE. A, LUBBOCK, TX 79413-6114
(806) 698-8088
(806) 698-8588
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA05964
TX
Other
Enumeration date
10/21/2008
Last updated
11/29/2022
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