Provider Demographics
NPI:1215695333
Name:MOORE, LORELEI (DNP, FNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-7603
Mailing Address - Country:US
Mailing Address - Phone:423-851-1650
Mailing Address - Fax:
Practice Address - Street 1:169 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-7603
Practice Address - Country:US
Practice Address - Phone:423-851-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine