Healthcare Provider Details

I. General information

NPI: 1205771268
Provider Name (Legal Business Name): LACI LOREE PISTOLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 COVE CREEK RD
QUITMAN AR
72131-8645
US

IV. Provider business mailing address

1475 COVE CREEK RD
QUITMAN AR
72131-8645
US

V. Phone/Fax

Practice location:
  • Phone: 870-421-5533
  • Fax:
Mailing address:
  • Phone: 870-421-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number235401
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: