Provider Demographics
NPI:1851721815
Name:CRESS, LORI A (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:CRESS
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:SONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:105 BRIDGE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-7012
Mailing Address - Country:US
Mailing Address - Phone:601-310-7738
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:105 BRIDGE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7012
Practice Address - Country:US
Practice Address - Phone:601-310-7738
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS323008YJ9FMedicare PIN