Healthcare Provider Details

I. General information

NPI: 1205789203
Provider Name (Legal Business Name): LAUREN BAGNATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOHN HOOVER PKWY BLDG 2
BURNET TX
78611
US

IV. Provider business mailing address

2880 FRONTERA DR APT 1220
ROUND ROCK TX
78681-1160
US

V. Phone/Fax

Practice location:
  • Phone: 512-715-3114
  • Fax:
Mailing address:
  • Phone: 412-660-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: