Healthcare Provider Details

I. General information

NPI: 1467735266
Provider Name (Legal Business Name): LAUREN COLLINS WALDROP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 S MADISON ST
TUPELO MS
38801-6309
US

IV. Provider business mailing address

1041 S MADISON ST
TUPELO MS
38801-6309
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-8754
  • Fax: 662-844-1973
Mailing address:
  • Phone: 662-844-8754
  • Fax: 662-844-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR874724
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: