Provider Demographics
NPI:1740580307
Name:LAZENBY, MEHGAN BLACKWELL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEHGAN
Middle Name:BLACKWELL
Last Name:LAZENBY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST DEPT ACB 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:502-561-7448
Mailing Address - Fax:502-561-7480
Practice Address - Street 1:550 S JACKSON ST DEPT ACB 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-561-7448
Practice Address - Fax:502-561-7480
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113065363LA2100X
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care