Provider Demographics
NPI:1801190277
Name:STEVENS, LORI ANN (PNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6165
Mailing Address - Country:US
Mailing Address - Phone:931-455-4682
Mailing Address - Fax:
Practice Address - Street 1:710 KINGS LN
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-5395
Practice Address - Country:US
Practice Address - Phone:931-455-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014502363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics