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NPI Code Detail

MEDICARE: LORI DESADIER APRN, AGPC-NP

MEDICARE: LORI DESADIER APRN, AGPC-NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAP08993LA

General Provider Information

NPI Number : 1265986152
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI DESADIER APRN, AGPC-NP
Provider Business Mailing Address
First Line : 515 N 3RD ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-6546
Country : US
Telephone Number : 903-475-3474
Fax Number : 903-367-0300
Provider Business Practice Location Address
First Line : 515 N 3RD ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-6546
Country : US
Telephone Number : 903-475-3474
Fax Number : 903-367-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2016
Last Update Date : 03/19/2025

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Directions to “ LORI DESADIER APRN, AGPC-NP” Practice Location

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