Provider Demographics
NPI:1932955846
Name:WALLS, LAUREN ALICIA (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALICIA
Last Name:WALLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25614 WENTINK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2716
Mailing Address - Country:US
Mailing Address - Phone:936-333-3532
Mailing Address - Fax:
Practice Address - Street 1:5016 E FM 1518 N
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1360
Practice Address - Country:US
Practice Address - Phone:210-654-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily