Individual
LORI BLANSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4381 S EASON BLVD STE 202, TUPELO, MS 38801-6585
(662) 377-6610
(662) 377-6614
Mailing address
4381 S EASON BLVD STE 202, TUPELO, MS 38801-6585
(662) 377-6610
(662) 377-6614
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
902990
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01906093
—
MS
Enumeration date
10/31/2018
Last updated
02/22/2019
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