MEDICARE: LAUREN CARLISLE HOLLIMAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R872453	MS
2	363LF0000X	Family Nurse Practitioner	R872453	MS

General Provider Information

NPI Number	:	1215263652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CARLISLE HOLLIMAN NP

Provider Business Mailing Address
First Line	:	499 GLOSTER CREEK VLG
Second Line	:	STE A2
City	:	TUPELO
State	:	MS
Zip	:	38801-4749
Country	:	US
Telephone Number	:	901-227-3255
Fax Number	:	901-227-8591

Provider Business Practice Location Address
First Line	:	255 BAPTIST BLVD., STE. 402
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2006
Country	:	US
Telephone Number	:	662-240-1412
Fax Number	:	662-240-1949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	09/18/2017

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