MEDICARE: LAUREN WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10210	TX

General Provider Information

NPI Number	:	1386091775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WHEELER

Provider Business Mailing Address
First Line	:	4515 MARSHA SHARP FWY
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-2520
Country	:	US
Telephone Number	:	806-744-7223
Fax Number	:	806-740-3325

Provider Business Practice Location Address
First Line	:	10705 MILWAUKEE AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-6153
Country	:	US
Telephone Number	:	806-701-5210
Fax Number	:	806-701-5211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	03/01/2023

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Directions to “ LAUREN WHEELER ” Practice Location

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