Healthcare Provider Details

I. General information

NPI: 1447717087
Provider Name (Legal Business Name): LORI W SEIVERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CLINIC DR STE A
PARIS KY
40361-2166
US

IV. Provider business mailing address

123 N WALNUT ST
CYNTHIANA KY
41031-1225
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-0302
  • Fax: 859-987-0358
Mailing address:
  • Phone: 859-588-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012912
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: