=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558764738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI WROTEN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2014
-----------------------------------------------------
Last Update Date | 10/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 MAIN ST E
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39653-9233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-384-3199
-----------------------------------------------------
Fax | 601-384-4101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 MAIN STREET EAST
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-384-3199
-----------------------------------------------------
Fax | 601-384-4101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R875090
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------