Provider Demographics
NPI:1023427952
Name:REILLY, LAUREN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:REILLY
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 1:7865 EDUCATORS LN STE 110
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8191
Mailing Address - Country:US
Mailing Address - Phone:901-384-9920
Mailing Address - Fax:901-937-7879
Practice Address - Street 1:7865 EDUCATORS LN STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8191
Practice Address - Country:US
Practice Address - Phone:901-384-9920
Practice Address - Fax:901-937-7879
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132242363LF0000X, 364SF0001X
TN20470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health