Healthcare Provider Details

I. General information

NPI: 1417483439
Provider Name (Legal Business Name): LORI WHEELER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TARPON TRL
JACKSONVILLE NC
28546-5287
US

IV. Provider business mailing address

10293 BRADFORD ST
KINGSTON OK
73439-2151
US

V. Phone/Fax

Practice location:
  • Phone: 580-565-6707
  • Fax:
Mailing address:
  • Phone: 580-565-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0012230
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5018992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: