Provider Demographics
NPI:1114363967
Name:LOYLESS, EMMA ROSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ROSE
Last Name:LOYLESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:ROSE
Other - Last Name:HEATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-1373
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-1373
Practice Address - Fax:318-966-4543
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily