Provider Demographics
NPI:1770880916
Name:MINSON, LORA BETH (ARNP)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:BETH
Last Name:MINSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:BETH
Other - Last Name:LOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1310 N HARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 DUNCAN REGIONAL LOOP
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1564
Practice Address - Country:US
Practice Address - Phone:580-251-6656
Practice Address - Fax:580-251-6668
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200321430AMedicaid
OK200321430AMedicaid