Provider Demographics
NPI:1609236967
Name:SCHOTT, LORI LYNN (ACNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:SCHOTT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3555 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3011
Mailing Address - Country:US
Mailing Address - Phone:928-757-8440
Mailing Address - Fax:
Practice Address - Street 1:3555 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3011
Practice Address - Country:US
Practice Address - Phone:928-757-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8486363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care