Provider Demographics
NPI:1205477510
Name:MAIN, LAUREN NICOLE (RN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:MAIN
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-0318
Mailing Address - Country:US
Mailing Address - Phone:903-683-3421
Mailing Address - Fax:903-683-7199
Practice Address - Street 1:805 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1006
Practice Address - Country:US
Practice Address - Phone:903-683-3421
Practice Address - Fax:903-683-7199
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142014363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX769136OtherREGISTERED NURSE
TXAP142014OtherPSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER