Healthcare Provider Details

I. General information

NPI: 1659307247
Provider Name (Legal Business Name): LORI K WITMER APRN/BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 FRAYSER BLVD COMMUNITY FAMILY MEDICAL
MEMPHIS TN
38127-5977
US

IV. Provider business mailing address

2595 CENTRAL AVE
MEMPHIS TN
38104-5905
US

V. Phone/Fax

Practice location:
  • Phone: 901-701-2540
  • Fax: 901-260-8449
Mailing address:
  • Phone: 901-260-8500
  • Fax: 901-260-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000124957
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007939
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003937
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: