Danette Lara
Individual provider Active NPI Athletic Trainer · Gorman, TX
NPI 1104550813 · NPPES record last updated Jul 11, 2022
Key facts
- NPI
- 1104550813
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 40674922 (TX)
- Practice address
- 414 N Potter St
Gorman, TX 76454-7645 - Phone
- (254) 734-5196
- NPI assigned
- Jul 11, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40674922 | TX | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | 40674922 | TX | Yes |
Addresses
Primary practice location
414 N Potter St
Gorman, TX 76454-7645
Mailing address
PO Box 125
Gorman, TX 76454-0125
Phone (254) 734-5196
Other providers in Gorman, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.