Provider Demographics
NPI:1104147032
Name:LORI ASHLOCK-RUDA FNP-C LLC
Entity type:Organization
Organization Name:LORI ASHLOCK-RUDA FNP-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLOCK-RUDA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:417-336-3627
Mailing Address - Street 1:800 STATE HIGHWAY 248
Mailing Address - Street 2:BLDG III UL
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3721
Mailing Address - Country:US
Mailing Address - Phone:417-336-3627
Mailing Address - Fax:
Practice Address - Street 1:800 STATE HIGHWAY 248
Practice Address - Street 2:BLDG III UL
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3721
Practice Address - Country:US
Practice Address - Phone:417-336-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO136833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty