Provider Demographics
NPI:1851744163
Name:LAWSON, NICKI E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NICKI
Middle Name:E
Last Name:LAWSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:NICKI
Other - Middle Name:E
Other - Last Name:RELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-2869
Mailing Address - Fax:601-815-9356
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-2869
Practice Address - Fax:601-815-9356
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL192717Medicaid
MS08482749Medicaid
MS08482749Medicaid