MEDICARE: LORIE MICHELLE WARDLOW APRN

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	363LA2200X	Adult Health Nurse Practitioner	4434P	KY

General Provider Information

NPI Number	:	1336111673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE MICHELLE WARDLOW APRN

Provider Business Mailing Address
First Line	:	427 US 31W BYP
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1703
Country	:	US
Telephone Number	:	270-796-8000
Fax Number	:	270-796-8000

Provider Business Practice Location Address
First Line	:	1573 KY HIGHWAY 259 N
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9206
Country	:	US
Telephone Number	:	270-597-2168
Fax Number	:	270-597-2168

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	12/22/2014

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