Provider Demographics
NPI:1063150779
Name:EMERSON, LAURA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 TRICKHAM BND
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1168
Mailing Address - Country:US
Mailing Address - Phone:575-202-3635
Mailing Address - Fax:
Practice Address - Street 1:1305 AIRPORT FWY STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6603
Practice Address - Country:US
Practice Address - Phone:469-320-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily