Healthcare Provider Details

I. General information

NPI: 1265986152
Provider Name (Legal Business Name): LORI DESADIER APRN, AGPC-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N 3RD ST
LONGVIEW TX
75601-6546
US

IV. Provider business mailing address

515 N 3RD ST
LONGVIEW TX
75601-6546
US

V. Phone/Fax

Practice location:
  • Phone: 903-475-3474
  • Fax: 903-367-0300
Mailing address:
  • Phone: 903-475-3474
  • Fax: 903-367-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08993
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: