Provider Demographics
NPI:1740201524
Name:LOFTIS, SHARON KAY (APN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9656
Mailing Address - Country:US
Mailing Address - Phone:479-619-6058
Mailing Address - Fax:
Practice Address - Street 1:1200 W. WALNUT
Practice Address - Street 2:SUITE 2200
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4032
Practice Address - Country:US
Practice Address - Phone:479-986-1300
Practice Address - Fax:479-986-1376
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAPN A01216363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136975758Medicaid