MEDICARE: DEIRDRE DENISE LOTT ARNP NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0065282	OK

General Provider Information

NPI Number	:	1205357910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE DENISE LOTT ARNP NP-C

Provider Business Mailing Address
First Line	:	4614 NE 67TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73121-9501
Country	:	US
Telephone Number	:	405-204-4429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4614 NE 67TH
Second Line	:
City	:	OKLAHOMA
State	:	OK
Zip	:	73121
Country	:	US
Telephone Number	:	405-204-4429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	07/21/2022

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