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NPI Code Detail

MEDICARE: LAUREN ELISE AGOSTINELLI WHNP-BC

MEDICARE: LAUREN ELISE AGOSTINELLI WHNP-BC
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
1363LW0102XWomen's Health Nurse Practitioner908036MS
2163W00000XRegistered Nurse921647MS

General Provider Information

NPI Number : 1669248522
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN ELISE AGOSTINELLI WHNP-BC
Provider Business Mailing Address
First Line : 205 BARRY STREET
Second Line :
City : LYON
State : MS
Zip : 38645
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 N STATE ST
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-6100
Country : US
Telephone Number : 662-627-7361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2023
Last Update Date : 04/08/2026

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