=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316499858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI ADKINS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2016
-----------------------------------------------------
Last Update Date | 11/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1735 SHERIDAN AVE STE 213
-----------------------------------------------------
City | CODY
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82414-3864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-213-0853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 372
-----------------------------------------------------
City | WAPITI
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82450-0372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-213-0853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 1711
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------