Healthcare Provider Details

I. General information

NPI: 1053962068
Provider Name (Legal Business Name): LAUREN LANIER GUTHRIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FRIARS CV
CLINTON MS
39056-3411
US

IV. Provider business mailing address

102 FRIARS CV
CLINTON MS
39056-3411
US

V. Phone/Fax

Practice location:
  • Phone: 601-383-5583
  • Fax:
Mailing address:
  • Phone: 601-383-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903581
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number903581
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: