Provider Demographics
NPI:1659307247
Name:WITMER, LORI K (APRN/BC, FNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:WITMER
Suffix:
Gender:F
Credentials:APRN/BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8500
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:969 FRAYSER BLVD
Practice Address - Street 2:COMMUNITY FAMILY MEDICAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5977
Practice Address - Country:US
Practice Address - Phone:901-701-2540
Practice Address - Fax:901-260-8449
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000124957163W00000X
TNAPN0000007939363LF0000X
ARA003937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
367978OtherANCC
ARA003937OtherAPRN, FNP
TNRN0000124957OtherRN LICENSE
AR3772OtherCERTIFICATE OF PRESCRIPTIVE AUTHORITY
TNAPN0000007939OtherAPN LICENSE
ARA003937OtherAPRN, FNP