Healthcare Provider Details

I. General information

NPI: 1295461671
Provider Name (Legal Business Name): LAUREN PAIGE VAN PELT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN SMITH

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 HANCOCK ST STE 404
GALLATIN TN
37066-6347
US

IV. Provider business mailing address

179 HANCOCK ST STE 404
GALLATIN TN
37066-6347
US

V. Phone/Fax

Practice location:
  • Phone: 615-328-3740
  • Fax: 615-328-3749
Mailing address:
  • Phone: 615-328-3740
  • Fax: 615-328-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5648
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: