Provider Demographics
NPI:1780631945
Name:MIDDLETON, LORI A (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:MIDDLETON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:MCKELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5329
Mailing Address - Country:US
Mailing Address - Phone:615-477-2133
Mailing Address - Fax:
Practice Address - Street 1:208 STERLING RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-5329
Practice Address - Country:US
Practice Address - Phone:615-477-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3903134Medicaid
TN3903134Medicaid