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General NPI Number Information
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NPI Number | 1104628015
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH SHIRLEY
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 800 5TH AVE STE 500
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City | FORT WORTH
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State | TX
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Zip | 76104-7304
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Country | US
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Telephone | 817-250-4280
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Fax | 817-250-4281
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Provider Business Mailing Address
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Address Line | 932 ROSEBUD DR
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City | AZLE
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State | TX
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Zip | 76020-2454
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Country | US
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Telephone | 817-991-5844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 799456
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA19265
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License Number State | TX
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