Healthcare Provider Details

I. General information

NPI: 1750299814
Provider Name (Legal Business Name): LAUREN BOWMAN CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN NOVARESE CST

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CENTER DR STE 100
MEMPHIS TN
38120-2352
US

IV. Provider business mailing address

752 JEFFRIES RD
POTTS CAMP MS
38659-9110
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-9030
  • Fax: 901-761-9591
Mailing address:
  • Phone: 901-761-9030
  • Fax: 901-761-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number100283797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: