Healthcare Provider Details

I. General information

NPI: 1124367644
Provider Name (Legal Business Name): LAURA LYNN KEYS N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAURA LYNN PHILLIPS

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 W MCDOWELL RD
JACKSON MS
39204-4217
US

IV. Provider business mailing address

1800 CLEARY RD
FLORENCE MS
39073-8137
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-3632
  • Fax: 601-372-7361
Mailing address:
  • Phone: 601-624-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR863885
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: