Provider Demographics
NPI:1386961449
Name:NAIL, LAURA (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NAIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FOUNTAINS BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6344
Mailing Address - Country:US
Mailing Address - Phone:769-300-0730
Mailing Address - Fax:
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-949-9994
Practice Address - Fax:601-949-2782
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily