Doctor Name: | MRS. LAURA JAY WEATHERMAN |
NPI Number: | 1790751196 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C, MPAS |
License Number: | PA-C, MPAS |
Business Practice Address: | 1510 N Bryan Ave Lamesa, TX - 793313143 |
Business Phone Number: | 8068727494 |
Business Fax Number: | 8068725917 |
Mailing Address: | Po Box 245, LAMESA |
State: | TX |
Postal Code: | 793310245 |
Phone Number: | 8064627386 |
Fax Number: | |
NPI Enumeration Date: | 02/24/2006 |
NPI Last Update Date: | 12/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA-C, MPAS |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |