| Brazosport Pediatric And Family Clinic Pllc | |
|
222 N Velasco St Ste A Angleton TX 77515-4576 | |
| (979) 300-0032 | |
| (979) 297-9096 |
| Full Name | Brazosport Pediatric And Family Clinic Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 222 N Velasco St Ste A, Angleton, Texas |
| Authorized Official Name and Position | Lauren Deann King (OWNER) |
| Authorized Official Contact | 9793000032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brazosport Pediatric And Family Clinic Pllc 222 N Velasco St Ste A Angleton TX 77515-4576 Ph: (979) 300-0032 | Brazosport Pediatric And Family Clinic Pllc 222 N Velasco St Ste A Angleton TX 77515-4576 Ph: (979) 300-0032 |
| NPI Number | 1467014753 |
|---|---|
| Provider Enumeration Date | 07/08/2019 |
| Last Update Date | 01/23/2024 |
| Medicare PECOS PAC ID | 0042547366 |
|---|---|
| Medicare Enrollment ID | O20190809000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467014753 | NPI | - | NPPES |
| 1740052984 | Other | TX | NPI |
| 1457645806 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lauren Deann King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932565025 PECOS PAC ID: 2860729183 Enrollment ID: I20190809000367 |
| Provider Name | Wanda Lanea Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740052984 PECOS PAC ID: 3173962842 Enrollment ID: I20240414000016 |
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