Healthcare Provider Details

I. General information

NPI: 1336111673
Provider Name (Legal Business Name): LORIE MICHELLE WARDLOW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 KY HIGHWAY 259 N
BROWNSVILLE KY
42210-9206
US

IV. Provider business mailing address

427 US 31W BYP
BOWLING GREEN KY
42101-1703
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2168
  • Fax: 270-597-2168
Mailing address:
  • Phone: 270-796-8000
  • Fax: 270-796-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4434P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: