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General NPI Number Information
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NPI Number | 1932641826
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Entity Type | Individual
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Provider Name | LAURA BETH CUNNINGHAM NP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 400 MID CITIES BLVD
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City | HURST
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State | TX
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Zip | 76054-2430
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Country | US
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Telephone | 817-554-8200
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Fax | 817-554-8204
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Provider Business Mailing Address
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Address Line | 400 MID CITIES BLVD
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City | HURST
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State | TX
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Zip | 76054-4013
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Country | US
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Telephone | 817-554-8200
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Fax | 817-554-8204
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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 | AP140645
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP-03172
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-03172
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 103013
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License Number State | OK
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