Healthcare Provider Details

I. General information

NPI: 1730593989
Provider Name (Legal Business Name): ERIN LAZENBY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN KRAMER

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PANTHER STADIUM DR
PETAL MS
39465-3632
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-2144
  • Fax: 601-450-2145
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-255-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN100625AP07799
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR852094
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: