Provider Demographics
NPI:1780449389
Name:MAG MEDICAL & MEDISPA, LLC
Entity type:Organization
Organization Name:MAG MEDICAL & MEDISPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:662-502-2903
Mailing Address - Street 1:307 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-1718
Mailing Address - Country:US
Mailing Address - Phone:662-502-2903
Mailing Address - Fax:662-507-2930
Practice Address - Street 1:307 UNION ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1718
Practice Address - Country:US
Practice Address - Phone:662-587-3405
Practice Address - Fax:662-507-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty