Healthcare Provider Details

I. General information

NPI: 1003555152
Provider Name (Legal Business Name): LAUREN EMILY CULBRETH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

2138 INVERNESS CT
OVIEDO FL
32765-5841
US

V. Phone/Fax

Practice location:
  • Phone: 407-683-4062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15974
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: