Healthcare Provider Details

I. General information

NPI: 1942314497
Provider Name (Legal Business Name): LOLITA L HORTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5683 S REX RD
MEMPHIS TN
38119-3821
US

IV. Provider business mailing address

1673 N ROYAL ST
JACKSON TN
38301-3607
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-0678
  • Fax: 901-350-0677
Mailing address:
  • Phone: 731-265-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000011700
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: