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General NPI Number Information
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NPI Number | 1851084321
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Entity Type | Individual
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Provider Name | JACQUELINE EVETT LAWRENCE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 4200 REGENT ST STE 200
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City | COLUMBUS
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State | OH
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Zip | 43219-6229
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Country | US
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Telephone | 877-870-1775
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Fax | 614-968-8840
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Provider Business Mailing Address
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Address Line | 903 69TH CT
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City | MERIDIAN
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State | MS
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Zip | 39305-8100
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Country | US
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Telephone | 304-516-3930
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F05230722
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95032706
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 906899
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024187405
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License Number State | VA
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