Provider Demographics
NPI:1114476207
Name:LOUGHRAN, KERRY ANN LOUGHRAN (CRNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN LOUGHRAN
Last Name:LOUGHRAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1048 W BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-6300
Mailing Address - Country:US
Mailing Address - Phone:484-621-1100
Mailing Address - Fax:
Practice Address - Street 1:1048 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6300
Practice Address - Country:US
Practice Address - Phone:484-621-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016489363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology