Provider Demographics
NPI:1407990872
Name:FUQUAY, LORI DILLARD (FNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:DILLARD
Last Name:FUQUAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 HILL LN
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-2174
Mailing Address - Country:US
Mailing Address - Phone:919-995-5421
Mailing Address - Fax:903-213-9122
Practice Address - Street 1:790 HILL LN
Practice Address - Street 2:
Practice Address - City:BRACEY
Practice Address - State:VA
Practice Address - Zip Code:23919-2174
Practice Address - Country:US
Practice Address - Phone:919-995-5421
Practice Address - Fax:903-213-9122
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131861363L00000X
TXAP120850363L00000X
TX811726363LF0000X
VA0024190402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1X7132OtherMEDICARE