Provider Demographics
NPI:1578717369
Name:LIPSCOMB, LORI L (ANP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 AIRWAYS BLVD STE 102A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-1106
Mailing Address - Country:US
Mailing Address - Phone:901-348-0200
Mailing Address - Fax:901-348-0046
Practice Address - Street 1:2831 AIRWAYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-1106
Practice Address - Country:US
Practice Address - Phone:901-348-0200
Practice Address - Fax:901-348-0046
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000055029163W00000X
TNAPN0000011411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440185Medicaid