Provider Demographics
NPI:1033576798
Name:TAYLOR, LORI (PHD, DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD, DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OLD HUMBOLDT RD STE D
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3506
Mailing Address - Country:US
Mailing Address - Phone:731-265-6456
Mailing Address - Fax:
Practice Address - Street 1:15 OLD HUMBOLDT RD STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3506
Practice Address - Country:US
Practice Address - Phone:731-256-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN20922363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner