1770880916 NPI number — LORA BETH MINSON ARNP

Table of content: LORA BETH MINSON ARNP (NPI 1770880916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770880916 NPI number — LORA BETH MINSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINSON
Provider First Name:
LORA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWRY
Provider Other First Name:
LORA
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770880916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 N HARVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73533-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 DUNCAN REGIONAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-251-6656
Provider Business Practice Location Address Fax Number:
580-251-6668
Provider Enumeration Date:
02/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  86125 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200321430A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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