Individual provider Active NPI

Lauren De'an Conner, P.A.-C.

  • Medical Physician Assistant
  • Livingston, TX
National Provider Identifier
1689851370
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA05605 Issued in TX
Practice address
210 W Park Ste 106
Livingston, TX 77351-8338
Phone
(936) 262-7161
Fax
(936) 262-7152
NPI assigned
Jan 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA05605 TX Primary

Addresses

Primary practice location

210 W Park Ste 106
Livingston, TX 77351-8338

Mailing address

210 W Park Ste 106
Livingston, TX 77351-8338
Phone (936) 262-7161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080827000631 TX Practitioner - Physician Assistant 6800962846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

1367 Dominion PLZ
Tyler, TX 75703-1013
Phone (903) 534-6200

210 W Park
Suite 106
Livingston, TX 77351-8338
Phone (936) 262-7161

901 Walnut Hill Dr
Longview, TX 75605-5054
Phone (903) 757-8878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA05605TXMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tyler County Hospital District Current Accepting new patients
Dermatology Associates Past Accepting new patients

Locations

104 N Beech St
Woodville, TX 75979
Phone (409) 283-2822

Interoperability endpoints

  • Direct secure messaging: laurenconner@tchfamilym.allscriptsdirect.net
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: lconner@dermatologyassociates.emadirect.md

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1689851370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W PARK STE 106",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773518338",
            "telephone_number": "936-262-7161",
            "fax_number": "936-262-7152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W PARK STE 106",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773518338",
            "telephone_number": "936-262-7161",
            "fax_number": "936-262-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "LAUREN",
        "middle_name": "DE'AN",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-25",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA05605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, TX

Sources for this page

Verify at the official NPI Registry.