Healthcare Provider Details

I. General information

NPI: 1922960632
Provider Name (Legal Business Name): LORRAINE ANDERSON WEST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S WEST ST
BAINBRIDGE GA
39819-4581
US

IV. Provider business mailing address

920 S WEST ST
BAINBRIDGE GA
39819-4581
US

V. Phone/Fax

Practice location:
  • Phone: 229-421-9411
  • Fax:
Mailing address:
  • Phone: 229-421-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP311214
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-002705
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11044222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: