Provider Demographics
NPI:1114650322
Name:JACKSON, LAUREN (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 MARTY LN
Mailing Address - Street 2:
Mailing Address - City:HATTIEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72063-8930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 MARTY LN
Practice Address - Street 2:
Practice Address - City:HATTIEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72063-8930
Practice Address - Country:US
Practice Address - Phone:501-977-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily