Provider Demographics
NPI:1659668408
Name:LOOMIS, MARY ELIZABETH MURPHY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELIZABETH
Middle Name:MURPHY
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1011 HIGHWAY 76 STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2531
Mailing Address - Country:US
Mailing Address - Phone:931-245-1150
Mailing Address - Fax:931-245-0605
Practice Address - Street 1:4280 WATERMELON RD STE 112
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5250
Practice Address - Country:US
Practice Address - Phone:205-750-0030
Practice Address - Fax:205-750-0855
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000016455OtherTN BOARD OF NURSING
AL1-113431OtherALABAMA BOARD OF NURSING