Healthcare Provider Details

I. General information

NPI: 1689038630
Provider Name (Legal Business Name): LAUREN DEAN MCKINNEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ANNE DEAN

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 E MAIN ST
HUMBOLDT TN
38343-2904
US

IV. Provider business mailing address

1636 E MAIN ST
HUMBOLDT TN
38343-2904
US

V. Phone/Fax

Practice location:
  • Phone: 731-784-7833
  • Fax:
Mailing address:
  • Phone: 731-784-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26575
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5635
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: