Provider Demographics
NPI:1639753882
Name:LITTLE, LORI ALEXANDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ALEXANDRA
Last Name:LITTLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-2046
Mailing Address - Country:US
Mailing Address - Phone:229-365-2570
Mailing Address - Fax:229-365-2571
Practice Address - Street 1:636 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079-2046
Practice Address - Country:US
Practice Address - Phone:229-365-2570
Practice Address - Fax:229-365-2571
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily