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General NPI Number Information
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NPI Number | 1265921985
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Entity Type | Organization
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Legal Business Name | NORTH LAUREL FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3115 AUDUBON DR
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City | LAUREL
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State | MS
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Zip | 39440
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Country | US
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Telephone | 601-531-2200
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Fax | 601-531-2220
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Provider Business Mailing Address
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Address Line | 3115 AUDUBON DR
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City | LAUREL
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State | MS
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Zip | 39440-1913
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Country | US
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Telephone | 601-531-2200
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Fax | 601-531-2220
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Authorized Official
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Title or Position | BILLING/CREDENTIALING
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Name | MRS. HOPE JACKSON
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Credential |
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Telephone | 601-498-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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