Provider Demographics
NPI:1922435858
Name:WHITSON, LAURA SUZANNE (ACNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUZANNE
Last Name:WHITSON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUZANNE
Other - Last Name:GOBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:254-202-9349
Practice Address - Street 1:100 HILLCREST MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8897
Practice Address - Country:US
Practice Address - Phone:254-202-2000
Practice Address - Fax:254-202-5651
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562664363LA2100X
TXAP124508363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329697201Medicaid
TX320995YQYYMedicare PIN