Provider Demographics
NPI:1790729663
Name:HILL, LAURIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:HILL
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 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-882-8053
Practice Address - Street 1:11805 SOUTH FWY STE 201
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7220
Practice Address - Country:US
Practice Address - Phone:817-759-7000
Practice Address - Fax:817-759-7027
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01940363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1947418-11Medicaid
TX1947418-10Medicaid
8550NQOtherBCBS
TX1947418-10Medicaid
TXTXB133448Medicare PIN
TX8L10051Medicare PIN
TX8K9113Medicare PIN
TX8K9114Medicare PIN
TXS44559Medicare UPIN
TX8L10049Medicare PIN
TX194741802Medicaid
TX8K9115Medicare PIN
TX87N341Medicare PIN