MEDICARE: MRS. KAITLIN M LONEY MA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1467243592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLIN M LONEY MA

Provider Business Mailing Address
First Line	:	1001 W BROAD ST
Second Line	:
City	:	REPUBLIC
State	:	MO
Zip	:	65738-2704
Country	:	US
Telephone Number	:	316-648-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 E CHESTNUT EXPY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-2555
Country	:	US
Telephone Number	:	417-848-1756
Fax Number	:

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

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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