Provider Demographics
NPI:1154307189
Name:EDGAR, LORI ANN (MSN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:EDGAR
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 CHARLIE HALL BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6099
Mailing Address - Country:US
Mailing Address - Phone:843-402-0227
Mailing Address - Fax:842-402-0232
Practice Address - Street 1:1938 CHARLIE HALL BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6099
Practice Address - Country:US
Practice Address - Phone:843-402-0227
Practice Address - Fax:843-402-0232
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0875Medicaid
SCP00638337OtherRAILROAD MEDICARE ID-PRIOR TO 5/1/09
SCP00820369OtherRAILROAD MEDICARE ID-RSFPN
SCP00820369OtherRAILROAD MEDICARE ID-RSFPN
SCP676415551Medicare PIN
SCP676419223Medicare PIN