Individual provider Active NPI

Mary Katherine Lawrence, APRN

  • Family Nurse Practitioner
  • Kosciusko, MS
National Provider Identifier
1063475440
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
672602 Issued in MS
Practice address
220 Highway 12 W
Kosciusko, MS 39090-3208
Phone
(662) 290-3150
Fax
(662) 290-3160
NPI assigned
Apr 7, 2006
Last updated
Jan 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 672602 MS Primary

Addresses

Primary practice location

220 Highway 12 W
Kosciusko, MS 39090-3208

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446
Phone (901) 227-3255

Other practice location 1

332 Highway 12 W
Kosciusko, MS 39090-3209
Phone (662) 289-1800

Other identifiers 1

IdentifierTypeStateIssuer
03338302MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050824000748 MS Practitioner - Nurse Practitioner 2365473857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
BMC - Attala, LLCGroup PAC ID 6204142771, 3 clinicians

Practice addresses (Care Compare)

220 Hwy 12 W
Kosciusko, MS 39090-3208
Phone (662) 289-4311

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
BMC - Attala, LLC CurrentSince Aug 22, 2016 Accepting new patients
Premier Medical Group of Mississippi LLC Past Accepting new patients
State Veterans Affairs Board PastSince Jul 26, 2004 Accepting new patients

Locations

220 Highway 12 W
Kosciusko, MS 39090
Phone (662) 289-4311

Interoperability endpoints

  • Direct secure messaging: mlawrence174383@direct.bmhcc.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1063475440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "telephone_number": "901-227-3255",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 HIGHWAY 12 W",
            "city": "KOSCIUSKO",
            "state": "MS",
            "postal_code": "390903208",
            "telephone_number": "662-290-3150",
            "fax_number": "662-290-3160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "332 Highway 12 W",
            "address_purpose": "LOCATION",
            "city": "Kosciusko",
            "state": "MS",
            "postal_code": "390903209",
            "country_code": "US",
            "telephone_number": "662-289-1800",
            "fax_number": "662-289-2486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "672602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03338302",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kosciusko, MS

Sources for this page

Verify at the official NPI Registry.