Provider Demographics
NPI:1104801893
Name:PICKRELL, LORI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:PICKRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-945-4589
Mailing Address - Fax:405-945-4381
Practice Address - Street 1:3400 NW EXPRESSWAY STE 500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4492
Practice Address - Country:US
Practice Address - Phone:405-945-4589
Practice Address - Fax:405-945-4381
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071550AMedicaid
OK200071550AMedicaid
OKI00392Medicare UPIN
OKOK100037Medicare PIN