Healthcare Provider Details

I. General information

NPI: 1972119766
Provider Name (Legal Business Name): LAUREN JESSICA KUEHHAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN WEISE KUEHHAS PA-C

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 ELIZABETH ST STE 804
CORPUS CHRISTI TX
78404-2231
US

IV. Provider business mailing address

5917 CROSSTOWN EXPY
CORPUS CHRISTI TX
78417-3504
US

V. Phone/Fax

Practice location:
  • Phone: 361-902-4343
  • Fax: 361-902-6000
Mailing address:
  • Phone: 361-854-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61075174
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: