Provider Demographics
NPI:1295164929
Name:GESICK, LAURA (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GESICK
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:MARFA
Mailing Address - State:TX
Mailing Address - Zip Code:79843-0267
Mailing Address - Country:US
Mailing Address - Phone:432-729-1812
Mailing Address - Fax:432-729-4023
Practice Address - Street 1:210 S. SUMMER ST.
Practice Address - Street 2:
Practice Address - City:MARFA
Practice Address - State:TX
Practice Address - Zip Code:79843-0267
Practice Address - Country:US
Practice Address - Phone:432-729-1812
Practice Address - Fax:432-729-4023
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily