Mag Medical & Medispa, LLC
Organization Active NPI Family Nurse Practitioner · Ripley, MS
NPI 1780449389 · NPPES record last updated Oct 24, 2024
Key facts
- NPI
- 1780449389
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- MAG MEDICAL & MEDISPA, LLC
- Practice address
- 307 Union St
Ripley, MS 38663-1718 - Phone
- (662) 587-3405
- Fax
- (662) 507-2930
- NPI assigned
- Feb 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lauren Kirkman, FNP-C
- Title
- Owner, FNP
- Phone
- (662) 502-2903
Practitioners 1
-
Lauren Kirkman, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2300636 | Mag Medical & Medispa | Certificate of waiver | Mar 12, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240418001015 | MS | Part B Supplier - Clinic/Group Practice | 2567801962 |
Receives reassigned benefits from 1 practitioner Practice locations: Ripley, MS |
National Provider Directory
Locations
307 Union St
Ripley, MS 38663
Phone (662) 502-2903
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
307 Union St
Ripley, MS 38663-1718
Mailing address
307 Union St
Ripley, MS 38663-1718
Phone (662) 502-2903
Other providers in Ripley, MS
- Shana Nicole Langford
- Diana Lynn Leonard
- Locke Drug Store Inc
- Raven Logan
- Karla Jean Lusby
- Magnolia State Family Medicine, LLC
- Beth March
- Carter Bailey Martin
- Martindale & Martindale PA
- Mark W Martindale
All providers in Ripley, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.