Provider Demographics
NPI:1568405942
Name:WEIS, LORI E (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:E
Last Name:WEIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:E
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 950296
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0296
Mailing Address - Country:US
Mailing Address - Phone:502-893-0220
Mailing Address - Fax:502-893-0563
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:#207
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-0220
Practice Address - Fax:502-893-0563
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4164P207RG0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012168Medicaid
KY4164POtherLICENSE
KY78012168Medicaid
Q06469Medicare UPIN
KY0727806Medicare PIN