Provider Demographics
NPI:1740300516
Name:WEATHERS, LORI BETH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:
Practice Address - Street 1:950 BAKER HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756-4168
Practice Address - Country:US
Practice Address - Phone:423-663-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000141508163W00000X
TN14375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF0609037OtherAANP NUMBER