Provider Demographics
NPI:1235683665
Name:BEISEL, LORI SANDERS
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:SANDERS
Last Name:BEISEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-736-8282
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:502 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3037
Practice Address - Country:US
Practice Address - Phone:601-736-8282
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS852035163W00000X
MS901884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse