Provider Demographics
NPI:1245698828
Name:AMBURGEY, LAUREN MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:AMBURGEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:EASTEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 HILL BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1481
Mailing Address - Country:US
Mailing Address - Phone:817-579-7557
Mailing Address - Fax:
Practice Address - Street 1:1305 N HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5117
Practice Address - Country:US
Practice Address - Phone:972-937-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant