Provider Demographics
NPI:1689856353
Name:KING, LORRI TEREESE (APRN)
Entity Type:Individual
Prefix:
First Name:LORRI
Middle Name:TEREESE
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORRI
Other - Middle Name:TEREESE
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:133 N WEST ST STE G
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2709
Mailing Address - Country:US
Mailing Address - Phone:443-494-8114
Mailing Address - Fax:
Practice Address - Street 1:133 N WEST ST STE G
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2709
Practice Address - Country:US
Practice Address - Phone:443-494-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002814A363LF0000X
KY3005389363LF0000X
MDR217052364SF0001X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100059580Medicaid
KY000000559785OtherANTHEM
KY0538785Medicare PIN