Healthcare Provider Details

I. General information

NPI: 1285735183
Provider Name (Legal Business Name): MELISSA A LOONEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W TYLER
WEST MEMPHIS AR
72301
US

IV. Provider business mailing address

PO BOX 1000 DEPT 960
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-2398
  • Fax: 870-732-3647
Mailing address:
  • Phone: 901-763-0200
  • Fax: 901-260-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA001693
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAO1693
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAPN0000012160
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: