Provider Demographics
NPI:1811447980
Name:ATTEBERRY, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ATTEBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 725
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644
Mailing Address - Country:US
Mailing Address - Phone:580-225-5900
Mailing Address - Fax:580-225-5901
Practice Address - Street 1:601 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-6014
Practice Address - Country:US
Practice Address - Phone:580-225-5900
Practice Address - Fax:580-225-5901
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily