1740201524 NPI number — MS. SHARON KAY LOFTIS APN

Table of content: MS. SHARON KAY LOFTIS APN (NPI 1740201524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740201524 NPI number — MS. SHARON KAY LOFTIS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOFTIS
Provider First Name:
SHARON
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740201524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72745-9656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-619-6058
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W. WALNUT
Provider Second Line Business Practice Location Address:
SUITE 2200
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72756-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-986-1300
Provider Business Practice Location Address Fax Number:
479-986-1376
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  APN A01216 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136975758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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