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NPI Code Detail

MEDICARE: LAURYN HALEY TAM PA-C

MEDICARE: LAURYN HALEY TAM PA-C
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
1363AM0700XMedical Physician AssistantTX

General Provider Information

NPI Number : 1386590362
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURYN HALEY TAM PA-C
Provider Business Mailing Address
First Line : 3016 CROCKETT ST APT 318
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2111 FORT WORTH HWY
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-4834
Country : US
Telephone Number : 972-544-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ LAURYN HALEY TAM PA-C” Practice Location

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