Provider Demographics
NPI:1427351261
Name:SHOPE, LORI L (RDLD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:SHOPE
Suffix:
Gender:F
Credentials:RDLD
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 39
Mailing Address - Street 2:
Mailing Address - City:EVARTS
Mailing Address - State:KY
Mailing Address - Zip Code:40828-0039
Mailing Address - Country:US
Mailing Address - Phone:606-837-2108
Mailing Address - Fax:606-837-9389
Practice Address - Street 1:101 CHAD STREET
Practice Address - Street 2:
Practice Address - City:EVARTS
Practice Address - State:KY
Practice Address - Zip Code:40828-0039
Practice Address - Country:US
Practice Address - Phone:606-837-2108
Practice Address - Fax:606-837-9389
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered