Individual
LORA A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
419 N SEMINARY ST, MADISONVILLE, KY 42431-1515
(731) 394-1145
(844) 374-0233
Mailing address
36 PEMBERTON CV, JACKSON, TN 38305-5514
(731) 394-1145
(844) 374-0233
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3012804
KY
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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