Provider Demographics
NPI:1588107791
Name:GUNNELL, LAUREN M (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:GUNNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 848476
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8476
Mailing Address - Country:US
Mailing Address - Phone:254-202-4655
Mailing Address - Fax:254-202-4697
Practice Address - Street 1:2304 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2467
Practice Address - Country:US
Practice Address - Phone:254-202-7300
Practice Address - Fax:254-202-7350
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2020-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ6586363A00000X
TXPA12088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant