Basic Information
Provider Information
NPI: 1275286387
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARTER
FirstName: LORI
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1440 LAND GROVE DR
Address2:  
City: KERNERSVILLE
State: NC
PostalCode: 272840117
CountryCode: US
TelephoneNumber: 3364080934
FaxNumber:  
Practice Location
Address1: 3803 N ELM ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274552593
CountryCode: US
TelephoneNumber: 3365402000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/28/2022
LastUpdateDate: 01/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCART-HC329NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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