Individual provider Active NPI

Laurel Rose Persa

  • Neurology with Special Qualifications in Child Neurology Physician
  • Austin, TX
National Provider Identifier
1235661588
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
V3411 Issued in TX
Practice address
9835 N Lake Creek Pkwy
Austin, TX 78717-6210
Phone
(737) 229-2000
NPI assigned
Mar 28, 2017
Last updated
Sep 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ML60759504 WA
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X V3411 TX Primary

Addresses

Primary practice location

9835 N Lake Creek Pkwy
Austin, TX 78717-6210

Mailing address

9835 N Lake Creek Pkwy
Austin, TX 78717-6210
Phone (737) 229-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221004000840 WA Practitioner - NeurologyPractitioner - Pediatric Medicine 5597033910 Reassigns benefits to 1 organization
I20240920001973 TX Practitioner - NeurologyPractitioner - Pediatric Medicine 5597033910 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ML60759504WAMDPediatrics Physician
V3411TXMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Sep 7, 2022 Accepting new patients
Multicare Health System CurrentSince Sep 7, 2022 Accepting new patients
Multicare Health System Current Accepting new patients
Texas Children's Physician Group Pediatrics CurrentSince Aug 19, 2024 Accepting new patients
Texas Children's Hospital Past Accepting new patients

Locations

8611 N Mopac Expy
Austin, TX 78759
Phone (713) 816-1250

101 W Expressway 83
McAllen, TX 78503
Phone (956) 661-9840

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

200 Lilly Rd NE
Ste C
Olympia, WA 98506
Phone (360) 918-8336

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

317 Martin Luther King Jr Way
Tacoma, WA 98405
Phone (253) 403-1400

Interoperability endpoints

  • Direct secure messaging: lpersa542118@prddirect.texaschildrens.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1235661588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9835 N LAKE CREEK PKWY",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787176210",
            "telephone_number": "737-229-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9835 N LAKE CREEK PKWY",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787176210",
            "telephone_number": "737-229-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSA",
        "first_name": "LAUREL",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "ML60759504",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "TX",
            "license": "V3411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.