MEDICARE: LORI MICHELLE GOODNIGHT FNP-BC

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	905317	MS

General Provider Information

NPI Number	:	1649990144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MICHELLE GOODNIGHT FNP-BC

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 HIGHWAY 614
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-6483
Country	:	US
Telephone Number	:	228-588-6622
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	10/13/2022

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