Provider Demographics
NPI:1528376894
Name:LOTT, ELIZABETH NICHOLS (CFNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICHOLS
Last Name:LOTT
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:NICHOLS
Other - Last Name:STIGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:P.O. BOX 633
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038
Mailing Address - Country:US
Mailing Address - Phone:662-247-2105
Mailing Address - Fax:662-247-4849
Practice Address - Street 1:107 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038
Practice Address - Country:US
Practice Address - Phone:662-247-2105
Practice Address - Fax:662-247-4849
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014025Medicaid
MS09014025Medicaid