Provider Demographics
NPI:1235741547
Name:KIRKMAN, LAUREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HIGHWAY 4 W
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-6802
Mailing Address - Country:US
Mailing Address - Phone:662-587-3405
Mailing Address - Fax:
Practice Address - Street 1:250 OAK STREET
Practice Address - Street 2:
Practice Address - City:HICKORY FLAT
Practice Address - State:MS
Practice Address - Zip Code:38633
Practice Address - Country:US
Practice Address - Phone:662-333-1128
Practice Address - Fax:662-333-1196
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF07202256OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
MS904082OtherMS BOARD OF NURSING