Provider Demographics
NPI:1407445141
Name:LOFTIS, VANESSA KAY (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KAY
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-5532
Mailing Address - Country:US
Mailing Address - Phone:417-553-5060
Mailing Address - Fax:417-647-6000
Practice Address - Street 1:1613 S JEFFERSON ST UNIT A
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-5639
Practice Address - Country:US
Practice Address - Phone:417-543-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216635363LF0000X, 363LP2300X, 363LX0106X
VA0024182076363LF0000X, 363LP2300X, 363LX0106X
MO2020038842363LX0106X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health