MEDICARE: MRS. LAURA KRISTINE PURKS PA

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	001009173	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1528626322	OTHER	NC	NPI

General Provider Information

NPI Number	:	1528626322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA KRISTINE PURKS PA

Provider Business Mailing Address
First Line	:	2741 CAMPUS WALK AVE STE 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-8878
Country	:	US
Telephone Number	:	919-391-7202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 CAMPUS WALK AVE BLDG 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-8878
Country	:	US
Telephone Number	:	919-391-7202
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	03/03/2026

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