Provider Demographics
NPI:1316499858
Name:ADKINS, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ADKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:WAPITI
Mailing Address - State:WY
Mailing Address - Zip Code:82450-0372
Mailing Address - Country:US
Mailing Address - Phone:307-213-0853
Mailing Address - Fax:
Practice Address - Street 1:1735 SHERIDAN AVE STE 213
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3864
Practice Address - Country:US
Practice Address - Phone:307-213-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1711171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator