Healthcare Provider Details

I. General information

NPI: 1609100536
Provider Name (Legal Business Name): JESSICA JOY LAWRENCE APN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

155 SHILOH DR
MARION AR
72364-2123
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-7600
  • Fax:
Mailing address:
  • Phone: 870-739-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000014274
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA03268ANP
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA810398
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: