Provider Demographics
NPI:1063931715
Name:PUGH, LAURA LEA (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:PUGH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 EMERALD DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6163
Mailing Address - Country:US
Mailing Address - Phone:979-224-3890
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST STE 235
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2586
Practice Address - Country:US
Practice Address - Phone:979-774-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily