Individual
LAURA K. HENTHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3370 S TEXAS AVE, SUITE B, BRYAN, TX 77802-3127
(979) 595-1700
(979) 595-1740
Mailing address
1500 UNIVERSITY DR E, #100, COLLEGE STATION, TX 77840-2600
(979) 383-2340
(979) 260-9390
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
616612
TX
363LF0000X
Family Nurse Practitioner
AP110479
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154467801
—
TX
01
—
1649265646
NPI CLINIC B
TX
01
—
1821185299
NPI AGENCY
TX
01
—
741715140
TAX ID
TX
Enumeration date
09/26/2005
Last updated
12/27/2019
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