Basic Information
| Provider Information | |||||||||
| NPI: | 1467807487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | GODWIN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SPRING HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366073326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514333344 | ||||||||
| FaxNumber: | 2514334052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-129469 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 1-129469 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LG0600X | 1-129469 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 102I507798 | 01 | AL | MEDICARE | OTHER | 213111 | 05 | AL | MEDICAID | 214623 | 05 | AL | MEDICAID | 4189859 | 01 | AL | AETNA | OTHER | 511-81870 | 01 | AL | BCBS | OTHER | 512-06505 | 01 | AL | BCBS | OTHER | 6071230 | 01 | AL | UHC | OTHER | 511-81869 | 01 | AL | BCBS | OTHER | 512-06493 | 01 | AL | BCBS | OTHER | Z69058 | 01 | AL | VIVA HEALTH | OTHER | 511-81861 | 01 | AL | BCBS | OTHER | 06809724 | 01 | MS | MS MEDICAID | OTHER | 210456 | 05 | AL | MEDICAID | 211441 | 05 | AL | MEDICAID | 212096 | 05 | AL | MEDICAID | P01701557 | 01 | AL | RR MEDICARE | OTHER | 191938 | 05 | AL | MEDICAID |