Provider Demographics
NPI:1396839429
Name:SOLIS, LORI SUZANNE (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:SUZANNE
Last Name:SOLIS
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TED A CROZIER SR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8912
Mailing Address - Country:US
Mailing Address - Phone:931-919-3361
Mailing Address - Fax:931-919-3362
Practice Address - Street 1:1100 TED A CROZIER SR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8912
Practice Address - Country:US
Practice Address - Phone:931-919-3361
Practice Address - Fax:931-919-3362
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000129156163W00000X
TN0000008121363LP0808X
KY3008447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30602015Medicaid
KYK115570OtherMEDICARE
TNQ001572Medicaid
TN103I504505OtherMEDICARE
KY3008447OtherKENTUCKY APRN LICENSE #
TN8121OtherTENNESSEE APRN LICENSE #
TNQ001572Medicaid