Provider Demographics
NPI:1104689587
Name:TANKSLEY, LAURA K (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 GLUCKSTADT RD STE B
Mailing Address - Street 2:
Mailing Address - City:GLUCKSTADT
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7228
Mailing Address - Country:US
Mailing Address - Phone:601-605-0452
Mailing Address - Fax:
Practice Address - Street 1:1030 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9553
Practice Address - Country:US
Practice Address - Phone:601-933-5635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care