Provider Demographics
NPI:1629308481
Name:CARAWAY, LAUREN LESAK (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LESAK
Last Name:CARAWAY
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 1:2903 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8809
Mailing Address - Country:US
Mailing Address - Phone:337-478-6480
Mailing Address - Fax:337-474-9637
Practice Address - Street 1:2903 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8809
Practice Address - Country:US
Practice Address - Phone:337-478-6480
Practice Address - Fax:337-474-9637
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06525363A00000X
LA200554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CF454OtherBCBSTX PROV. #
TX875N30OtherBC/BS #
TXP00852590OtherRAILROAD MEDICARE
TX307406401Medicaid
TXP00852590OtherRAILROAD MEDICARE
TXTXB157320Medicare PIN