Provider Demographics
NPI:1104195213
Name:HUGHES, LAUREN M (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:469-532-0273
Practice Address - Street 1:3321 YUCCA DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2743
Practice Address - Country:US
Practice Address - Phone:972-505-2551
Practice Address - Fax:972-521-3240
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297396801Medicaid
TXTXB151963Medicare PIN