Provider Demographics
NPI:1932641826
Name:CUNNINGHAM, LAURA BETH (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:BURKITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 MID CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-4013
Mailing Address - Country:US
Mailing Address - Phone:817-554-8200
Mailing Address - Fax:817-554-8204
Practice Address - Street 1:400 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2430
Practice Address - Country:US
Practice Address - Phone:817-554-8200
Practice Address - Fax:817-554-8204
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140645363LF0000X
NMCNP-03172363L00000X, 363LF0000X
OK103013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse