Provider Demographics
NPI:1558539239
Name:BATISTA, LAURA D (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:BATISTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:713-790-2082
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:SUITE B452
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:713-790-2082
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195508001Medicaid
TX195508003Medicaid
TX8DY4001OtherBLUE CROSS BLUE SHIELD
TXP01074746OtherRR MEDICARE
TX195508002Medicaid
TX8Y9489OtherBLUE CROSS BLUE SHIELD
TXP00783100OtherMEDICARE RAILROAD
TX8Y4001OtherBLUE CROSS BLUE SHIELD
TX195508002Medicaid
TX483321YUD8Medicare PIN
TXP01074746OtherRR MEDICARE
TXTXB138407Medicare PIN
TX8Y9489OtherBLUE CROSS BLUE SHIELD
TX8DY4001OtherBLUE CROSS BLUE SHIELD