Healthcare Provider Details

I. General information

NPI: 1285887240
Provider Name (Legal Business Name): LORI L MCNEIL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 09/24/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

301 FISHER STREET
KAFB MS
39434
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5678
  • Fax: 601-984-5638
Mailing address:
  • Phone: 228-376-3059
  • Fax: 228-376-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP012528
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR620017
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: