Provider Demographics
NPI:1285887240
Name:MCNEIL, LORI L (CRNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FISHER STREET
Mailing Address - Street 2:
Mailing Address - City:KAFB
Mailing Address - State:MS
Mailing Address - Zip Code:39434
Mailing Address - Country:US
Mailing Address - Phone:228-376-3059
Mailing Address - Fax:228-376-0101
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5678
Practice Address - Fax:601-984-5638
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012528363LA2100X
MSR620017363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02825807Medicaid
MSP01551498Medicare PIN
MS302I507050Medicare PIN