Provider Demographics
NPI:1720622194
Name:COUTURE, LAUREN WARD (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WARD
Last Name:COUTURE
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 1:1500 LEWIS TURNER BLVD APT M304
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-7204
Mailing Address - Country:US
Mailing Address - Phone:251-363-5529
Mailing Address - Fax:
Practice Address - Street 1:550 REDSTONE AVE W STE 490
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6457
Practice Address - Country:US
Practice Address - Phone:850-689-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112670363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical