Provider Demographics
NPI:1821497561
Name:FOLKENS, LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FOLKENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 GUNBARREL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7252
Mailing Address - Country:US
Mailing Address - Phone:423-493-5220
Mailing Address - Fax:423-493-5228
Practice Address - Street 1:1510 GUNBARREL RD STE 120
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7252
Practice Address - Country:US
Practice Address - Phone:423-493-5220
Practice Address - Fax:423-493-5228
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004011363AS0400X
TXPA09902363AS0400X
TN3789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418582YKPWMedicare PIN