1396839429 NPI number — DR. LORI SUZANNE SOLIS DNP, APRN, PMHNP-BC

Table of content: DR. LORI SUZANNE SOLIS DNP, APRN, PMHNP-BC (NPI 1396839429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396839429 NPI number — DR. LORI SUZANNE SOLIS DNP, APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLIS
Provider First Name:
LORI
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396839429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 TED A CROZIER SR BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-919-3361
Provider Business Mailing Address Fax Number:
931-919-3362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 TED A CROZIER SR BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-8912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-919-3361
Provider Business Practice Location Address Fax Number:
931-919-3362
Provider Enumeration Date:
10/03/2006

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: 163W00000X , with the licence number:  0000129156 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 0000008121 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: 3008447 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30602015 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K115570 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: Q001572 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103I504505 . This is a "MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3008447 . This is a "KENTUCKY APRN LICENSE #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8121 . This is a "TENNESSEE APRN LICENSE #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".