Healthcare Provider Details

I. General information

NPI: 1912974999
Provider Name (Legal Business Name): LAURA LYNN ROONEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 JUNCTION HWY
KERRVILLE TX
78028-5056
US

IV. Provider business mailing address

551 HILL COUNTRY DR
KERRVILLE TX
78028-6085
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-6300
  • Fax:
Mailing address:
  • Phone: 830-258-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number625694
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP111025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: