MEDICARE: LAURA MORRISS KOEN MSN, APRN, FNP-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	363LF0000X	Family Nurse Practitioner	1171328	TX

General Provider Information

NPI Number	:	1457171399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MORRISS KOEN MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	8518 CULEBRA RD STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4846
Country	:	US
Telephone Number	:	210-910-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	8518 CULEBRA RD STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4846
Country	:	US
Telephone Number	:	210-910-5550
Fax Number	:

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/28/2024

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