Healthcare Provider Details

I. General information

NPI: 1750460135
Provider Name (Legal Business Name): LAURA RHONE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 N BEACH ST SUITE 140
FORT WORTH TX
76137-1299
US

IV. Provider business mailing address

4504 BOAT CLUB RD SUITE 800
FORT WORTH TX
76135-7003
US

V. Phone/Fax

Practice location:
  • Phone: 817-281-2977
  • Fax: 817-788-2530
Mailing address:
  • Phone: 817-237-4794
  • Fax: 817-237-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: