Provider Demographics
NPI:1598804478
Name:HESS, LAUREN RAE (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:HESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SCRIPTURE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2376
Mailing Address - Country:US
Mailing Address - Phone:940-323-3655
Mailing Address - Fax:
Practice Address - Street 1:2505 SCRIPTURE ST STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2376
Practice Address - Country:US
Practice Address - Phone:940-323-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04211363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX442913YKTPMedicare PIN
TX8C6930Medicare ID - Type UnspecifiedMEDICARE PROVIDER