Provider Demographics
NPI:1083086615
Name:STLAWRENCE, BRANDON PAUL (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PAUL
Last Name:STLAWRENCE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:PAUL
Other - Last Name:ST. LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3539 LAKEARIES LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449
Mailing Address - Country:US
Mailing Address - Phone:281-704-1429
Mailing Address - Fax:
Practice Address - Street 1:23900 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1323
Practice Address - Country:US
Practice Address - Phone:281-644-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily