Healthcare Provider Details

I. General information

NPI: 1659668408
Provider Name (Legal Business Name): MARY ELIZABETH MURPHY LOOMIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH MURPHY NP-C

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 WATERMELON RD STE 112
NORTHPORT AL
35473-5250
US

IV. Provider business mailing address

1011 HIGHWAY 76 STE A
CLARKSVILLE TN
37043-2531
US

V. Phone/Fax

Practice location:
  • Phone: 205-750-0030
  • Fax: 205-750-0855
Mailing address:
  • Phone: 931-245-1150
  • Fax: 931-245-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000016455
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: