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General NPI Number Information
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NPI Number | 1407990872
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Entity Type | Individual
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Provider Name | LORI DILLARD FUQUAY FNP
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Gender | Female
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 790 HILL LN
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City | BRACEY
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State | VA
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Zip | 23919-2174
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Country | US
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Telephone | 919-995-5421
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Fax | 903-213-9122
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Provider Business Mailing Address
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Address Line | 790 HILL LN
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City | BRACEY
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State | VA
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Zip | 23919-2174
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Country | US
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Telephone | 919-995-5421
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Fax | 903-213-9122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 131861
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP120850
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 811726
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024190402
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License Number State | VA
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