Provider Demographics
NPI:1982864930
Name:LOTT, ANDREW B (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:LOTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E BAKER ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2450
Mailing Address - Country:US
Mailing Address - Phone:662-887-5235
Mailing Address - Fax:662-887-4111
Practice Address - Street 1:121 E BAKER ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2450
Practice Address - Country:US
Practice Address - Phone:662-887-5235
Practice Address - Fax:662-887-4111
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852953367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered