Healthcare Provider Details

I. General information

NPI: 1275599599
Provider Name (Legal Business Name): LORRI A JULIAN-TROTTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORRI A TROTTER

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10763 HWY 39 STE. 200
MT. VERNON MO
65712-7823
US

IV. Provider business mailing address

PO BOX 505673
SAINT LOUIS MO
63150-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2460
  • Fax: 416-269-2462
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number128702
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: