Provider Demographics
NPI:1255844478
Name:PABON, LAUREN BOYNTON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BOYNTON
Last Name:PABON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:BOYNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:140 ALLEN COURT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860
Mailing Address - Country:US
Mailing Address - Phone:803-510-0007
Mailing Address - Fax:803-510-0144
Practice Address - Street 1:140 ALLEN COURT
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860
Practice Address - Country:US
Practice Address - Phone:803-510-0007
Practice Address - Fax:803-510-0144
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4993Medicaid