Provider Demographics
NPI:1063767093
Name:STAUDENMAIER, LORI PURKEY (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:PURKEY
Last Name:STAUDENMAIER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:PURKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-381-1509
Practice Address - Street 1:7211 WELLINGTON DR STE 201
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5968
Practice Address - Country:US
Practice Address - Phone:865-584-5762
Practice Address - Fax:833-908-2098
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2607207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program