Provider Demographics
NPI:1265712145
Name:NIMON, LAURIE SELMAN (NP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:SELMAN
Last Name:NIMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:SELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-326-1501
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-326-1501
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily