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General NPI Number Information
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NPI Number | 1932132917
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Entity Type | Individual
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Provider Name | GRANT KEITH LOFTON CFNP
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 E WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39216-5116
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Country | US
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Telephone | 601-362-4471
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Fax | 601-364-1425
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Provider Business Mailing Address
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Address Line | 709 CHARLIE DIXON RD
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City | BRAXTON
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State | MS
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Zip | 39044-9315
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Country | US
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Telephone | 601-362-4471
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Fax | 601-364-1425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | R587052
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License Number State | MS
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