Provider Demographics
NPI:1437419009
Name:LOTT, BRENDE L (APRN)
Entity Type:Individual
Prefix:
First Name:BRENDE
Middle Name:L
Last Name:LOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-3319
Mailing Address - Country:US
Mailing Address - Phone:270-789-6087
Mailing Address - Fax:270-789-6119
Practice Address - Street 1:105 GREENBRIAR DR STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9617
Practice Address - Country:US
Practice Address - Phone:270-465-3568
Practice Address - Fax:270-789-6119
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007440363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology