Healthcare Provider Details

I. General information

NPI: 1831258383
Provider Name (Legal Business Name): LORI A TIMBERLAKE APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W BROAD ST
COLUMBUS OH
43204-2653
US

IV. Provider business mailing address

140 E TOWN ST STE 1450
COLUMBUS OH
43215-6601
US

V. Phone/Fax

Practice location:
  • Phone: 614-334-6903
  • Fax:
Mailing address:
  • Phone: 614-334-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 09196
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP09196
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number09196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: