MEDICARE: LORI LEA ELLIS NP

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	AO1691	AR

General Provider Information

NPI Number	:	1396748380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LEA ELLIS NP

Provider Business Mailing Address
First Line	:	606 W ARCH AVE
Second Line	:	STE A
City	:	SEARCY
State	:	AR
Zip	:	72143-5206
Country	:	US
Telephone Number	:	501-279-0211
Fax Number	:	501-279-0213

Provider Business Practice Location Address
First Line	:	606 W ARCH AVE
Second Line	:	STE A
City	:	SEARCY
State	:	AR
Zip	:	72143-5206
Country	:	US
Telephone Number	:	501-279-0211
Fax Number	:	501-279-0213

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/04/2007

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Directions to “ LORI LEA ELLIS NP” Practice Location

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