Individual
NANCY LUETHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701
(903) 606-5400
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601004191
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
399520101
—
TX
01
—
8LD264
BCBS
TX
Enumeration date
03/17/2006
Last updated
09/03/2019
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