Provider Demographics
NPI:1679335541
Name:GRANGER, LARA ALAYNA (NP)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:ALAYNA
Last Name:GRANGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SHADY LANE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-1826
Mailing Address - Country:US
Mailing Address - Phone:214-797-0447
Mailing Address - Fax:
Practice Address - Street 1:4251 CROSS TIMBERS RD STE 160
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3006
Practice Address - Country:US
Practice Address - Phone:469-300-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily