Basic Information
| Provider Information | |||||||||
| NPI: | 1629037015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUBBARD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C, RD,LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3711 IDA DR | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765495510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105197370 | ||||||||
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| Practice Location | |||||||||
| Address1: | 36000 DARNALL LOOP | ||||||||
| Address2: | CARL R DARNALL ARMY MEDICAL CENTER | ||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765445095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542888025 | ||||||||
| FaxNumber: | 2542867188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 03/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT06571 | TX | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.