Provider Demographics
NPI:1396098349
Name:GAUTAM, LAXMI (NP-C)
Entity type:Individual
Prefix:
First Name:LAXMI
Middle Name:
Last Name:GAUTAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24048 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5326
Mailing Address - Country:US
Mailing Address - Phone:281-255-3897
Mailing Address - Fax:
Practice Address - Street 1:24048 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5326
Practice Address - Country:US
Practice Address - Phone:281-255-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721385363LF0000X
TXAP122620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily