Provider Demographics
NPI:1316164163
Name:BAYLISS, LAWRENCE (APRN)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:BAYLISS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 KRAMER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4013
Mailing Address - Country:US
Mailing Address - Phone:512-978-9000
Mailing Address - Fax:
Practice Address - Street 1:825 E RUNDBERG LN
Practice Address - Street 2:SUITE B1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4808
Practice Address - Country:US
Practice Address - Phone:512-978-9600
Practice Address - Fax:512-978-9601
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165513603Medicaid
TX8G3195Medicare ID - Type UnspecifiedPROVIDER