Provider Demographics
NPI:1588385991
Name:KIM, LAUREN (RN, CNM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2081 LAKE PARK DR SE APT E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7636
Mailing Address - Country:US
Mailing Address - Phone:716-517-5473
Mailing Address - Fax:
Practice Address - Street 1:253 VETERANS DR STE 210
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3076
Practice Address - Country:US
Practice Address - Phone:716-517-5473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife