Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP131296 | TX |
NPI | 1003269580 |
---|---|
Provider Name | Mrs. Lauren Hailey Morton |
First Address | Decatur, TX 76234-6156 |
Second Address | Boyd, TX 76023-3072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 30/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366735401 | (05) | TX |
8703NY | BCBSTX (01) | TX |