Healthcare Provider Details

I. General information

NPI: 1083246730
Provider Name (Legal Business Name): LORI SHOTT APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 THOMPSON RD STE E
COOS BAY OR
97420-2040
US

IV. Provider business mailing address

1957 THOMPSON RD STE E
COOS BAY OR
97420-2040
US

V. Phone/Fax

Practice location:
  • Phone: 541-236-2778
  • Fax: 866-892-1157
Mailing address:
  • Phone: 541-236-2778
  • Fax: 866-892-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200341669RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020003768NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: