Provider Demographics
NPI:1710949912
Name:BURNS, LORI DAVIS (CRNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DAVIS
Last Name:BURNS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:CLIETT
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3980 COLONNADE PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2382
Mailing Address - Country:US
Mailing Address - Phone:205-510-5000
Mailing Address - Fax:
Practice Address - Street 1:708 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1836
Practice Address - Country:US
Practice Address - Phone:205-203-8282
Practice Address - Fax:205-203-8286
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891006070Medicaid
AL110109Medicaid
051552710Medicare PIN
AL102I503017Medicare PIN
ALR76889Medicare UPIN