Provider Demographics
NPI:1104163807
Name:DURRETT, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DURRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 PRIVATE ROAD 6460
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1547
Mailing Address - Country:US
Mailing Address - Phone:806-438-6565
Mailing Address - Fax:
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709823363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner