MEDICARE: LAUREN CATHRINE DEASON AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	1141746	TX

General Provider Information

NPI Number	:	1942074414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CATHRINE DEASON AGACNP-BC

Provider Business Mailing Address
First Line	:	200 W MAGNOLIA AVE STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7657
Country	:	US
Telephone Number	:	817-702-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4941
Country	:	US
Telephone Number	:	817-701-3431
Fax Number	:

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/17/2023

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