Provider Demographics
NPI:1134567761
Name:HIMSCHOOT, LORI (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HIMSCHOOT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-6789
Mailing Address - Country:US
Mailing Address - Phone:662-538-4636
Mailing Address - Fax:
Practice Address - Street 1:6200 BRENTWOOD CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-6789
Practice Address - Country:US
Practice Address - Phone:662-538-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1180544163W00000X
KY3015572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse