Lauren Fairbanks, NP
Individual provider Active NPI Family Nurse Practitioner · Melissa, TX
NPI 1780169953 · NPPES record last updated Apr 3, 2021
Key facts
- NPI
- 1780169953
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP139030 (TX)
- Practice address
- 3591 McKinney St Ste 400
Melissa, TX 75454-9504 - Phone
- (972) 464-1611
- NPI assigned
- Oct 3, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181025002784 | TX | Practitioner - Nurse Practitioner | 6709139488 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP139030 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Plano Urgent Care LLC | Current |
Accepting new patients |
Locations
901 W 15th St
Plano, TX 75075
Phone (469) 443-0275
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP139030 | TX | Yes |
Addresses
Primary practice location
3591 McKinney St Ste 400
Melissa, TX 75454-9504
Mailing address
16775 Addison Rd Ste 200
Addison, TX 75001-5654
Phone (972) 913-6216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP139030 | Other | TX | TEXAS BOARD OF NURSING |
| F09180217 | Other | TX | TEXAS BOARD OF NURSING |
Other providers in Melissa, TX
- Alfred Douglas
- DTK Ventures LLC
- Kayla Nicole Edwards
- Bobby Carroll Erwin
- George Eyakoh
- Shazia Farooqui
- Fastmart Traders LLC
- Flex Pediatrics, LLC
- Lindsey Fordham
- Robert James Fox
All providers in Melissa, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.