Provider Demographics
NPI:1649573833
Name:LOFTON, SHARON B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:B
Last Name:LOFTON
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 1:300 NISSAN DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8562
Mailing Address - Country:US
Mailing Address - Phone:601-855-8426
Mailing Address - Fax:601-855-6392
Practice Address - Street 1:33795 MS-12
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:MS
Practice Address - Zip Code:39063
Practice Address - Country:US
Practice Address - Phone:662-653-0505
Practice Address - Fax:662-653-0466
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR705268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112368Medicaid