Provider Demographics
NPI:1306269337
Name:HULL, LAURA (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HULL
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 1:2251 COUNTRY CLUB DRIVE
Mailing Address - Street 2:STE 131
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:682-518-1100
Mailing Address - Fax:682-518-1104
Practice Address - Street 1:2251 COUNTRY CLUB DRIVE
Practice Address - Street 2:STE 131
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:682-518-1100
Practice Address - Fax:682-518-1104
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01324619OtherRAILROAD MEDICARE
TXPA08828Other578135YYKJ