Provider Demographics
NPI:1194212910
Name:ATKINSON, LAURA CLAIRE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CLAIRE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 CAMP BOWIE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6313
Mailing Address - Country:US
Mailing Address - Phone:817-244-4620
Mailing Address - Fax:817-560-7159
Practice Address - Street 1:8030 CAMP BOWIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6313
Practice Address - Country:US
Practice Address - Phone:817-244-4620
Practice Address - Fax:817-560-7159
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine