Provider Demographics
NPI:1932100054
Name:LAURSEN, KERRY ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNETTE
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 HIGHWAY 6
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4777
Mailing Address - Country:US
Mailing Address - Phone:281-276-0653
Mailing Address - Fax:281-276-0691
Practice Address - Street 1:8330 HIGHWAY 6
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4777
Practice Address - Country:US
Practice Address - Phone:281-276-0653
Practice Address - Fax:281-276-0691
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170771301Medicaid
TX170773903Medicaid
TX170773904Medicaid
TX8EU201OtherBCBS
TX8FT352OtherBCBS
TX170773901Medicaid
TX170773902Medicaid
TX170773901Medicaid
TX391468YQ64Medicare PIN
TX170773904Medicaid
TX170773902Medicaid
TX391468YMVQMedicare PIN