Provider Demographics
NPI:1457654451
Name:DARNELL, LAURA LIN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LIN
Last Name:DARNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LIN
Other - Last Name:KRIZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-539-8128
Mailing Address - Fax:940-432-3640
Practice Address - Street 1:609 MEDICAL CENTER DR STE 1200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3835
Practice Address - Country:US
Practice Address - Phone:940-539-8128
Practice Address - Fax:940-432-3640
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8RV361OtherBCBS
TX1457654451Medicaid