Provider Demographics
NPI:1780662189
Name:HENSON, LORRIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2430
Mailing Address - Country:US
Mailing Address - Phone:931-520-4887
Mailing Address - Fax:931-528-5859
Practice Address - Street 1:137 W 2ND ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2430
Practice Address - Country:US
Practice Address - Phone:931-520-4887
Practice Address - Fax:931-528-5859
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39752207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4110690OtherBLUE CROSS BLUE SHIELD
TN3331956Medicaid
202927531OtherTRICARE
TN3331956Medicaid
202927531OtherTRICARE