Provider Demographics
NPI:1639219173
Name:MIMS, LORA N (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:N
Last Name:MIMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 BLUEBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-7836
Mailing Address - Country:US
Mailing Address - Phone:334-361-3187
Mailing Address - Fax:
Practice Address - Street 1:RR 2, BOX 4D, HWY 45 S
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756
Practice Address - Country:US
Practice Address - Phone:334-683-9085
Practice Address - Fax:334-683-9082
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-049124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily