Provider Demographics
NPI:1447434295
Name:TITTSWORTH, LAURA SADLER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SADLER
Last Name:TITTSWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E FM 1187
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4358
Mailing Address - Country:US
Mailing Address - Phone:817-568-2023
Mailing Address - Fax:817-568-2738
Practice Address - Street 1:901 E FM 1187
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4358
Practice Address - Country:US
Practice Address - Phone:817-568-2023
Practice Address - Fax:817-568-2738
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06794363A00000X, 363AM0700X
KYTC070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447434295Medicaid