Basic Information
| Provider Information | |||||||||
| NPI: | 1255451555 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARSONS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | 6515 KEMP BLVD, WICHITA FALLS, TX 76308 | ||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | 6515 KEMP BLVD, WICHITA FALLS, TX 76308 | ||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | H8787 | TX | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | P089G5420 | 05 | TX | MEDICAID |