Provider Demographics
NPI:1598350399
Name:BUSBY, LAUREN OLIVIA (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:OLIVIA
Last Name:BUSBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OAK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6201
Mailing Address - Country:US
Mailing Address - Phone:601-750-6675
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3470
Practice Address - Country:US
Practice Address - Phone:601-376-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904492363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics