Healthcare Provider Details

I. General information

NPI: 1427591627
Provider Name (Legal Business Name): LAUREN BREWER BECKMAN AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BREWER CNP

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINCOLN PKWY STE 103
HATTIESBURG MS
39402-3261
US

IV. Provider business mailing address

30 CIRCLE J DR STE 1
LAUREL MS
39440-1981
US

V. Phone/Fax

Practice location:
  • Phone: 601-261-1600
  • Fax:
Mailing address:
  • Phone: 601-425-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22087
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number903381
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: