Provider Demographics
NPI:1215263652
Name:HOLLIMAN, LAUREN CARLISLE (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CARLISLE
Last Name:HOLLIMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:J
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:499 GLOSTER CREEK VLG
Mailing Address - Street 2:STE A2
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4749
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:255 BAPTIST BLVD., STE. 402
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2006
Practice Address - Country:US
Practice Address - Phone:662-240-1412
Practice Address - Fax:662-240-1949
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872453363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily