Provider Demographics
NPI:1649371238
Name:WHITE, LAURA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2628
Mailing Address - Country:US
Mailing Address - Phone:214-232-5180
Mailing Address - Fax:
Practice Address - Street 1:400 W IH 635 FWY
Practice Address - Street 2:PLAZA I, SUITE 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3718
Practice Address - Country:US
Practice Address - Phone:972-481-6363
Practice Address - Fax:972-406-2732
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03969363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280814904Medicaid
TX280814901Medicaid
TX280814902Medicaid
TXTXB123628Medicare PIN
TX280814904Medicaid
TX280814901Medicaid
TXTXB123626Medicare PIN