Basic Information
Provider Information | |||||||||
NPI: | 1629466792 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LORING | ||||||||
FirstName: | KELLY | ||||||||
MiddleName: | DAVEY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSN-FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 110 S WOODLAND ST | ||||||||
Address2: |   | ||||||||
City: | WINTER GARDEN | ||||||||
State: | FL | ||||||||
PostalCode: | 347873546 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079058827 | ||||||||
FaxNumber: | 4079058998 | ||||||||
Practice Location | |||||||||
Address1: | 2140 N DON WICKHAM DR | ||||||||
Address2: |   | ||||||||
City: | CLERMONT | ||||||||
State: | FL | ||||||||
PostalCode: | 347111923 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079058827 | ||||||||
FaxNumber: | 4076601667 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/24/2014 | ||||||||
LastUpdateDate: | 01/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP17114 | OH | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APRN11004283 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.