Provider Demographics
NPI:1114429974
Name:LIGHTNER, LAURA GRACIELA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GRACIELA
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 961783
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-1783
Mailing Address - Country:US
Mailing Address - Phone:915-777-3151
Mailing Address - Fax:915-855-6111
Practice Address - Street 1:11890 VISTA DEL SOL DR STE A-117
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2501
Practice Address - Country:US
Practice Address - Phone:915-777-3151
Practice Address - Fax:915-855-6111
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP136410363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409916001Medicaid