MEDICARE: LORI MICHELLE HART

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
1	363LF0000X	Family Nurse Practitioner	1-097039	AL

General Provider Information

NPI Number	:	1992261259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MICHELLE HART

Provider Business Mailing Address
First Line	:	300 EASTLAND HILLS DR
Second Line	:
City	:	LINCOLN
State	:	AL
Zip	:	35096-4082
Country	:	US
Telephone Number	:	256-375-9955
Fax Number	:

Provider Business Practice Location Address
First Line	:	7063 VETERANS PKWY
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-5114
Country	:	US
Telephone Number	:	256-375-9955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	01/24/2022

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