Healthcare Provider Details

I. General information

NPI: 1386452407
Provider Name (Legal Business Name): LUCY LOOPER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E 3RD ST
SHERIDAN WY
82801-3674
US

IV. Provider business mailing address

75 EAST THIRD STREET
SHERIDAN WY
82801
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-8548
  • Fax:
Mailing address:
  • Phone: 307-752-8548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-263811
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-263811
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number55836
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: