Healthcare Provider Details

I. General information

NPI: 1710472758
Provider Name (Legal Business Name): RAGEN LAYNE RAWSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 1250
JACKSON MS
39216-4609
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-5955
  • Fax:
Mailing address:
  • Phone: 601-200-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902627
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: