Provider Demographics
NPI:1467807487
Name:KING, LAUREN GODWIN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:GODWIN
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:5955 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3135
Practice Address - Country:US
Practice Address - Phone:251-633-0573
Practice Address - Fax:251-633-7367
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129469363L00000X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06809724OtherMS MEDICAID
AL210456Medicaid
AL4189859OtherAETNA
AL212096Medicaid
AL511-81869OtherBCBS
AL6071230OtherUHC
ALP01701557OtherRR MEDICARE
AL191938Medicaid
AL211441Medicaid
AL102I507798OtherMEDICARE
AL214623Medicaid
AL511-81861OtherBCBS
AL511-81870OtherBCBS
AL512-06493OtherBCBS
AL512-06505OtherBCBS
AL213111Medicaid
ALZ69058OtherVIVA HEALTH