Active NPI
Lori Elizabeth Secerovic, NP
- Family Nurse Practitioner
- Desoto, TX
National Provider Identifier
1043987738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2021040600
- Practice address
- 1111 South Interstate 35 East
Desoto, TX 75115 - Phone
- (469) 341-7800
- NPI assigned
- Aug 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2021040600 | TX | Primary |
Addresses
Primary practice location
1111 South Interstate 35 East
Desoto, TX 75115
Mailing address
3412 Dwyer LN
Flower Mound, TX 75022-2869
Phone (239) 691-4027
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021040600 | TX | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630281600000",
"number": "1043987738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3412 DWYER LN",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "750222869",
"telephone_number": "239-691-4027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 SOUTH INTERSTATE 35 EAST",
"city": "DESOTO",
"state": "TX",
"postal_code": "75115",
"telephone_number": "469-341-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SECEROVIC",
"first_name": "LORI",
"middle_name": "ELIZABETH",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-30",
"last_updated": "2021-08-30",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "2021040600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desoto, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.