Provider Demographics
NPI:1497712293
Name:CHENEY, LORI MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:CHENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BURNETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-492-5995
Mailing Address - Fax:870-508-8900
Practice Address - Street 1:250 DRILLERS RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5186
Practice Address - Country:US
Practice Address - Phone:870-492-5995
Practice Address - Fax:870-508-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2471207R00000X
ARE-2471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141038001Medicaid
H19960Medicare UPIN
AR141038001Medicaid