Provider Demographics
NPI:1497764047
Name:KUTAC, LAUREN KELLY (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KELLY
Last Name:KUTAC
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N TEXANA ST
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-2021
Mailing Address - Country:US
Mailing Address - Phone:361-798-3671
Mailing Address - Fax:361-798-3128
Practice Address - Street 1:1406 N TEXANA ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2021
Practice Address - Country:US
Practice Address - Phone:361-798-3671
Practice Address - Fax:361-798-3128
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0705076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily