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NPI Code Detail

MEDICARE: LORIE RASHELLE WYDOTIS APRN, FNP-C

MEDICARE: LORIE RASHELLE WYDOTIS APRN, FNP-C
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
1163W00000XRegistered Nurse1083029KY
2363LF0000XFamily Nurse Practitioner3009572KY
3207RC0000XCardiovascular Disease Physician3009572KY

General Provider Information

NPI Number : 1457731770
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORIE RASHELLE WYDOTIS APRN, FNP-C
Provider Business Mailing Address
First Line : 100 MEDICAL CENTER DR
Second Line :
City : PRINCETON
State : KY
Zip : 42445-2430
Country : US
Telephone Number : 270-365-0350
Fax Number :
Provider Business Practice Location Address
First Line : 100 MEDICAL CENTER DR
Second Line :
City : PRINCETON
State : KY
Zip : 42445-2430
Country : US
Telephone Number : 270-365-0350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2015
Last Update Date : 02/11/2025

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