Provider Demographics
NPI:1164897823
Name:LOFTIS, ASHLEY LANIECE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LANIECE
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:AR
Mailing Address - Zip Code:72029-2706
Mailing Address - Country:US
Mailing Address - Phone:870-747-3085
Mailing Address - Fax:
Practice Address - Street 1:245 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:AR
Practice Address - Zip Code:72029-2706
Practice Address - Country:US
Practice Address - Phone:870-747-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-631363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical