=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285961102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAQUEISHA J. HAMILTON FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2009
-----------------------------------------------------
Last Update Date | 11/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11003 SHADOW CREEK PKWY
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-7401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-582-0161
-----------------------------------------------------
Fax | 281-582-0162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 CADILLAC DR SUITE 250
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-425-4225
-----------------------------------------------------
Fax | 615-425-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 712889
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------