Healthcare Provider Details

I. General information

NPI: 1548257579
Provider Name (Legal Business Name): LARA K ROWE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 US HIGHWAY 271 N STE 300
PITTSBURG TX
75686-4289
US

IV. Provider business mailing address

2701 US HIGHWAY 271 N STE 300
PITTSBURG TX
75686-4289
US

V. Phone/Fax

Practice location:
  • Phone: 903-946-5442
  • Fax: 903-946-5258
Mailing address:
  • Phone: 903-946-5442
  • Fax: 903-946-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number662253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: