Healthcare Provider Details

I. General information

NPI: 1710949912
Provider Name (Legal Business Name): LORI DAVIS BURNS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI CLIETT DAVIS CRNP

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 MONTGOMERY HWY
VESTAVIA HILLS AL
35216-1836
US

IV. Provider business mailing address

3980 COLONNADE PKWY
BIRMINGHAM AL
35243-2382
US

V. Phone/Fax

Practice location:
  • Phone: 205-203-8282
  • Fax: 205-203-8286
Mailing address:
  • Phone: 205-510-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-078713
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: