MEDICARE: JOSEPH DAVID RICHARD LOONEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	2022006529	MO

General Provider Information

NPI Number	:	1235092206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH DAVID RICHARD LOONEY

Provider Business Mailing Address
First Line	:	3616 CLEVES AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1737
Country	:	US
Telephone Number	:	314-660-4026
Fax Number	:	314-660-4026

Provider Business Practice Location Address
First Line	:	10010 KENNERLY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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