Provider Demographics
NPI:1447421409
Name:YOUNG, LAURIE ELIZABETH BUSKIRK (FNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELIZABETH BUSKIRK
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ELIZABETH
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5749
Mailing Address - Country:US
Mailing Address - Phone:662-377-5395
Mailing Address - Fax:662-377-5390
Practice Address - Street 1:806 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5749
Practice Address - Country:US
Practice Address - Phone:662-377-5395
Practice Address - Fax:662-377-5390
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02374OtherMEDICARE GROUP