Healthcare Provider Details

I. General information

NPI: 1083579544
Provider Name (Legal Business Name): LORI ANN BRISTOL MS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 ARENDELL ST
MOREHEAD CITY NC
28557-2901
US

IV. Provider business mailing address

114 LAKE ARTHUR DR
NEWPORT NC
28570-5402
US

V. Phone/Fax

Practice location:
  • Phone: 252-499-8565
  • Fax:
Mailing address:
  • Phone: 252-499-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number185669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: