Lauren A Self
Individual provider Active NPI Athletic Trainer · Lorman, MS
NPI 1407192081 · NPPES record last updated Dec 30, 2012
Key facts
- NPI
- 1407192081
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT0629 (MS)
- Practice address
- 1000 Asu Dr
#510
Lorman, MS 39096-7500 - Phone
- (601) 877-2483
- Fax
- (601) 877-3821
- NPI assigned
- Dec 30, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT0629 | MS | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT0629 | MS | Yes |
Addresses
Primary practice location
1000 Asu Dr
#510
Lorman, MS 39096-7500
Mailing address
1000 Asu Dr
#510
Lorman, MS 39096-7500
Phone (601) 877-2483
Other providers in Lorman, MS
- Carexus Home Health Alliance
- Cultivated Hands Home Care, LLC
- Nia Thompson Day
- Journey'S Holistic Health and Healing Arts Center
- Ivy London Smothers
- Brittany Ann Trahan
All providers in Lorman, MS · Athletic Trainer in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.