Provider Demographics
NPI:1386471365
Name:RIVERS, LAUREN LEIGH
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 SHELL OIL RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-8433
Mailing Address - Country:US
Mailing Address - Phone:601-955-8147
Mailing Address - Fax:
Practice Address - Street 1:185 MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-1248
Practice Address - Country:US
Practice Address - Phone:601-362-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily