Basic Information
| Provider Information | |||||||||
| NPI: | 1750678991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANCOCK | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | LATISHA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6032 BEAVER CREEK LN | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724049558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704053073 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 225 E JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724013119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702071630 | ||||||||
| FaxNumber: | 8702076581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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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 | 363LF0000X | A03570 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | A03570 | 01 | AR | ARKANSAS STATE BOARD OF NURSING | OTHER |