Basic Information
| Provider Information | |||||||||
| NPI: | 1386931715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUCK | ||||||||
| FirstName: | LORRI | ||||||||
| MiddleName: | LIVERS | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 BACK RUN RD | ||||||||
| Address2: | |||||||||
| City: | COXS CREEK | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400137609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022759898 | ||||||||
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| Practice Location | |||||||||
| Address1: | 608 HAPPY VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GLASGOW | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421411561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709015000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2011 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 28193545A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 3006993 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7100230750 | 05 | KY | MEDICAID |