Provider Demographics
NPI:1447717087
Name:SEIVERS, LORI W (APRN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:W
Last Name:SEIVERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1225
Mailing Address - Country:US
Mailing Address - Phone:859-588-5215
Mailing Address - Fax:
Practice Address - Street 1:24 CLINIC DR STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2166
Practice Address - Country:US
Practice Address - Phone:859-987-0302
Practice Address - Fax:859-987-0358
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100628500Medicaid