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General NPI Number Information
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NPI Number | 1316529241
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Entity Type | Individual
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Provider Name | LAUREN HALASE JACKSON MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1860 CHADWICK DR STE 300
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City | JACKSON
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State | MS
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Zip | 39204-3470
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Country | US
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Telephone | 601-376-2857
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Fax |
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Provider Business Mailing Address
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Address Line | 421 CUMBERLAND CT
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City | MADISON
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State | MS
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Zip | 39110-7375
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Country | US
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Telephone | 601-455-4893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904777
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 906902
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License Number State | MS
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