Individual
LAUREN BOTELER ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2500 N STATE ST, CHILD DEVELOPMENT CENTER, JACKSON, MS 39216-4500
(601) 984-2955
Mailing address
2500 N STATE ST, CHILD DEVELOPMENT CENTER, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
901482
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03754078
—
MS
Enumeration date
03/28/2016
Last updated
06/23/2016
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