Healthcare Provider Details

I. General information

NPI: 1235741547
Provider Name (Legal Business Name): LAUREN KIRKMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 OAK STREET
HICKORY FLAT MS
38633
US

IV. Provider business mailing address

4750 HIGHWAY 4 W
RIPLEY MS
38663-6802
US

V. Phone/Fax

Practice location:
  • Phone: 662-333-1128
  • Fax: 662-333-1196
Mailing address:
  • Phone: 662-587-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904082
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: