Provider Demographics
NPI:1164619144
Name:LOVELL, LYDIA JACKSON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:JACKSON
Last Name:LOVELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E CHAMBERS DR
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-8903
Mailing Address - Country:US
Mailing Address - Phone:662-720-4816
Mailing Address - Fax:662-720-4832
Practice Address - Street 1:2301 E CHAMBERS DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-8903
Practice Address - Country:US
Practice Address - Phone:662-720-4816
Practice Address - Fax:662-720-4832
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily