Provider Demographics
NPI:1245240225
Name:LUCAS, NANCY S (AUD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:S
Last Name:LUCAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11797 SOUTH FWY STE 132
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7035
Mailing Address - Country:US
Mailing Address - Phone:817-551-0466
Mailing Address - Fax:
Practice Address - Street 1:5049 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4213
Practice Address - Country:US
Practice Address - Phone:817-645-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
51496231HA2500X
TX51496231HA2400X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner