Provider Demographics
NPI:1316529241
Name:JACKSON, LAUREN HALASE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:HALASE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7375
Mailing Address - Country:US
Mailing Address - Phone:601-455-4893
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3470
Practice Address - Country:US
Practice Address - Phone:601-376-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906902163W00000X
MS904777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse