Provider Demographics
NPI:1760148779
Name:CONNOR, LAURA KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHERINE
Last Name:CONNOR
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 1:4641 MONTROSE BLVD APT 953
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6157
Mailing Address - Country:US
Mailing Address - Phone:615-336-4927
Mailing Address - Fax:
Practice Address - Street 1:4747 BELLAIRE BLVD STE 575
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4535
Practice Address - Country:US
Practice Address - Phone:713-575-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty