MEDICARE: LAUREN ALICIA WALLS NP

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	363LF0000X	Family Nurse Practitioner	1158767	TX

General Provider Information

NPI Number	:	1932955846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ALICIA WALLS NP

Provider Business Mailing Address
First Line	:	25614 WENTINK AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-2716
Country	:	US
Telephone Number	:	936-333-3532
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 E FM 1518 N
Second Line	:
City	:	SELMA
State	:	TX
Zip	:	78154-1360
Country	:	US
Telephone Number	:	210-654-9300
Fax Number	:

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

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	08/22/2024

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Directions to “ LAUREN ALICIA WALLS NP” Practice Location

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