Provider Demographics
NPI:1235167586
Name:HORNELL, LAUREN LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LYNN
Last Name:HORNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:6210 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4413
Practice Address - Country:US
Practice Address - Phone:903-579-2700
Practice Address - Fax:903-579-2799
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00277158OtherMEDICARE RR
H11698Medicare UPIN
P00277158Medicare PIN
P00277158OtherMEDICARE RR