Healthcare Provider Details

I. General information

NPI: 1932611951
Provider Name (Legal Business Name): LAUREN HARKRIDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FM 2181 STE 100
HICKORY CREEK TX
75065-7636
US

IV. Provider business mailing address

3600 FM 2181 STE 100
HICKORY CREEK TX
75065-7636
US

V. Phone/Fax

Practice location:
  • Phone: 940-498-4422
  • Fax: 940-321-1045
Mailing address:
  • Phone: 940-498-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: