Provider Demographics
NPI:1720769151
Name:BLACKBURN, LAUREN (DNP PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ASHLEYS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7258
Mailing Address - Country:US
Mailing Address - Phone:662-801-6403
Mailing Address - Fax:
Practice Address - Street 1:2716 W OXFORD LOOP
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5721
Practice Address - Country:US
Practice Address - Phone:662-638-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9061362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry