=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730522178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ANN CROOM NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2013
-----------------------------------------------------
Last Update Date | 10/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 FRY RD STE O
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449-6233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-321-3452
-----------------------------------------------------
Fax | 833-746-4523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23110 CINCO RANCH BLVD
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-2891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-598-1824
-----------------------------------------------------
Fax | 713-929-9448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 794738
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AP123511
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------