Provider Demographics
NPI:1255066940
Name:KEMP, MAGEAN LASHAE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAGEAN
Middle Name:LASHAE
Last Name:KEMP
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-7485
Mailing Address - Country:US
Mailing Address - Phone:256-436-2264
Mailing Address - Fax:
Practice Address - Street 1:199 PINE GROVE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-7485
Practice Address - Country:US
Practice Address - Phone:256-436-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141385363LP0808X
COC-APN.0004543-C-NP363LP0808X
MS905442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health