=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588448526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. LORI ANNE IRONS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2023
-----------------------------------------------------
Last Update Date | 08/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1686 W US HIGHWAY 79
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75831-3490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-322-1290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75855-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-806-7980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 1128851
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------