Provider Demographics
NPI:1912517822
Name:SPAULDING, LAURA KATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHERINE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATI - NICKNAME
Other - Middle Name:
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 BLANCO CT
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4227
Mailing Address - Country:US
Mailing Address - Phone:817-875-0529
Mailing Address - Fax:
Practice Address - Street 1:1316 BLANCO CT
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-4227
Practice Address - Country:US
Practice Address - Phone:817-875-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677678163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse