Provider Demographics
NPI:1124367644
Name:KEYS, LAURA LYNN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:KEYS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 CLEARY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-8137
Mailing Address - Country:US
Mailing Address - Phone:601-624-5432
Mailing Address - Fax:
Practice Address - Street 1:1963 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4217
Practice Address - Country:US
Practice Address - Phone:601-372-3632
Practice Address - Fax:601-372-7361
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03355409Medicaid
MS271299YJ5DMedicare PIN