Provider Demographics
NPI:1417294828
Name:LOFTIS, MARY ANNE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1011 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1331
Mailing Address - Country:US
Mailing Address - Phone:417-466-7191
Mailing Address - Fax:417-466-3876
Practice Address - Street 1:1011 S EAST ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1331
Practice Address - Country:US
Practice Address - Phone:417-466-7191
Practice Address - Fax:417-466-3876
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000293363LF0000X
MO1417294828363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care