Provider Demographics
NPI:1356465603
Name:SPURLOCK, LORA D (NP)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:D
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LORA
Other - Middle Name:D
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1124 FOX MEADOWS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6927
Mailing Address - Country:US
Mailing Address - Phone:865-446-0224
Mailing Address - Fax:865-365-1777
Practice Address - Street 1:1124 FOX MEADOWS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6927
Practice Address - Country:US
Practice Address - Phone:865-446-0224
Practice Address - Fax:833-365-1777
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11536363L00000X
TN11536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341090Medicaid
TN33410902Medicare PIN