Provider Demographics
NPI:1225658149
Name:LOOPER, DESIREE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:ANN
Last Name:LOOPER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:ANN
Other - Last Name:ACTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2939
Mailing Address - Country:US
Mailing Address - Phone:870-743-9000
Mailing Address - Fax:870-743-4949
Practice Address - Street 1:825 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2939
Practice Address - Country:US
Practice Address - Phone:870-743-9000
Practice Address - Fax:870-743-4949
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124544OtherSTATE LICENSE, AR STATE BOARD OF NURSING