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General NPI Number Information
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NPI Number | 1740276591
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Entity Type | Individual
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Provider Name | LAURA K. HENTHORN FNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 3370 S TEXAS AVE SUITE B
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City | BRYAN
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State | TX
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Zip | 77802-3127
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Country | US
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Telephone | 979-595-1700
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Fax | 979-595-1740
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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E #100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2600
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Country | US
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Telephone | 979-383-2340
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Fax | 979-260-9390
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP110479
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 616612
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License Number State | TX
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