MEDICARE: LAUREN ELIZABETH CARLSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	PA17068	TX
2	363A00000X	Physician Assistant	PA17068	TX

General Provider Information

NPI Number	:	1043095706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELIZABETH CARLSON PA-C

Provider Business Mailing Address
First Line	:	4402 BROADWAY BLVD STE 1
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-3400
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 BROADWAY BLVD STE 1
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-3400
Country	:	US
Telephone Number	:	972-240-1789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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