Healthcare Provider Details

I. General information

NPI: 1922877091
Provider Name (Legal Business Name): LORI LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 TENNOVA MEDICAL WAY
KNOXVILLE TN
37909-3120
US

IV. Provider business mailing address

1240 TENNOVA MEDICAL WAY
KNOXVILLE TN
37909-3120
US

V. Phone/Fax

Practice location:
  • Phone: 865-444-3770
  • Fax:
Mailing address:
  • Phone: 865-444-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36566
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000247972
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: