Provider Demographics
NPI:1487225587
Name:RAYBURN, LAURA (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:RAYBURN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18310 EDWARDS BLF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3547
Mailing Address - Country:US
Mailing Address - Phone:210-996-1136
Mailing Address - Fax:
Practice Address - Street 1:5309 WURZBACH RD STE 200-10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2444
Practice Address - Country:US
Practice Address - Phone:210-647-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046955363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care