Provider Demographics
NPI:1235605163
Name:FORD, LAUREN KATE (APRN, WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:KATE
Last Name:FORD
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:KATE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3910
Mailing Address - Country:US
Mailing Address - Phone:318-212-8951
Mailing Address - Fax:318-212-6752
Practice Address - Street 1:2400 HOSPITAL DR STE 240
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2390
Practice Address - Country:US
Practice Address - Phone:318-212-7931
Practice Address - Fax:318-212-7935
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10154363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2483781Medicaid