Provider Demographics
NPI:1457450827
Name:MCBRIDE, LORI D (APN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2860
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-2860
Mailing Address - Country:US
Mailing Address - Phone:501-315-4008
Mailing Address - Fax:501-315-3411
Practice Address - Street 1:1000 HIGHWAY 35 N STE 8
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2353
Practice Address - Country:US
Practice Address - Phone:501-315-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP000034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner