Provider Demographics
NPI:1205249471
Name:FORRESTER, LORI HALL (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:HALL
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8541
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0011
Mailing Address - Country:US
Mailing Address - Phone:662-889-1010
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6583
Practice Address - Country:US
Practice Address - Phone:662-377-5700
Practice Address - Fax:662-377-5715
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902001363LA2100X
MSR877171363LA2100X
TN18777363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care