Basic Information
| Provider Information | |||||||||
| NPI: | 1275599599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JULIAN-TROTTER | ||||||||
| FirstName: | LORRI | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| OtherLastName: | TROTTER | ||||||||
| OtherFirstName: | LORRI | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 4046 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658084046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172695712 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 10763 HWY 39 | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | MT. VERNON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657127823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172692460 | ||||||||
| FaxNumber: | 4162692462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 128702 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 220435 | 01 | MO | ANTHEM | OTHER | 33658031 | 01 | BCBS | OTHER | 428384820 | 05 | MO | MEDICAID |