=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831022466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEARL PSYCHIATRY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 S 16TH ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-4409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-876-1549
-----------------------------------------------------
Fax | 662-735-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 165
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-0165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-876-1549
-----------------------------------------------------
Fax | 662-735-4500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/NP
-----------------------------------------------------
Name | DR. LAUREN BLACKBURN
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 662-876-1549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------