Healthcare Provider Details

I. General information

NPI: 1205249471
Provider Name (Legal Business Name): LORI HALL FORRESTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 S EASON BLVD SUITE 302
TUPELO MS
38801-6583
US

IV. Provider business mailing address

PO BOX 8541
COLUMBUS MS
39705-0011
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-5700
  • Fax: 662-377-5715
Mailing address:
  • Phone: 662-889-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number902001
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR877171
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number18777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: