Provider Demographics
NPI:1801522990
Name:THIRTY-THREE MEDSPA
Entity type:Organization
Organization Name:THIRTY-THREE MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-416-2737
Mailing Address - Street 1:208 WESTOVER HTS
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-1106
Mailing Address - Country:US
Mailing Address - Phone:166-241-6273
Mailing Address - Fax:
Practice Address - Street 1:725 HIGHWAY 145 S
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-8913
Practice Address - Country:US
Practice Address - Phone:662-416-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty