Provider Demographics
NPI:1235647009
Name:STARKS, LAURA PATRICIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:PATRICIA
Last Name:STARKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:PATRICIA
Other - Last Name:HEATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:
Practice Address - Street 1:300 MAPLE ST W
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-3238
Practice Address - Country:US
Practice Address - Phone:843-943-3813
Practice Address - Fax:803-943-5971
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5137Medicaid