Healthcare Provider Details

I. General information

NPI: 1780229641
Provider Name (Legal Business Name): LAUREN BLAKENEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MCKEE FNP

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE 103
FLOWOOD MS
39232-9531
US

IV. Provider business mailing address

434 KATHERINE DR
FLOWOOD MS
39232-8810
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax: 601-948-6544
Mailing address:
  • Phone: 769-243-6141
  • Fax: 601-510-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902351
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: