Individual
LAKESHIA TAMARA CARTER-LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-4141
Mailing address
3151 WINFIELD SCOTT RD RM 366, JBSA FT SAM HOUSTON, TX 78234-7669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
1091556
ZZ
Other
Enumeration date
09/19/2011
Last updated
11/13/2020
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