Individual provider Active NPI

Lauryn Hicks, FNP-C

  • Family Nurse Practitioner
  • Moselle, MS
National Provider Identifier
1194598763
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
906300 Issued in MS
Practice address
3 John Everett Rd
Moselle, MS 39459-9771
Phone
(601) 620-9991
NPI assigned
Nov 6, 2023
Last updated
Dec 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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 906300 MS Primary

Addresses

Primary practice location

3 John Everett Rd
Moselle, MS 39459-9771

Mailing address

1946 Gladiolus Dr
Laurel, MS 39440-4818
Phone (601) 335-2269

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
I20231212004231 MS Practitioner - Nurse Practitioner 2264881499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grayson Creek Medical Clinic LLCGroup PAC ID 1153605233, 3 clinicians

Practice addresses (Care Compare)

3 John Everett Rd
Moselle, MS 39459-9771
Phone (601) 620-9991

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
906300MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grayson Creek Medical Clinic, LLC Family CurrentSince Nov 6, 2023 Accepting new patients
Smith Audiology, LLC CurrentSince Nov 24, 2024 Accepting new patients

Locations

3 John Everett Rd
Moselle, MS 39459
Phone (601) 475-9304

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1194598763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1946 GLADIOLUS DR",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404818",
            "telephone_number": "601-335-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 JOHN EVERETT RD",
            "city": "MOSELLE",
            "state": "MS",
            "postal_code": "394599771",
            "telephone_number": "601-620-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "LAURYN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moselle, MS

Sources for this page

Verify at the official NPI Registry.