Doctor Name: | MIKA SEAY LOOSEY |
NPI Number: | 1699086892 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | A003424 |
Business Practice Address: | 4188 Hwy 177 South Jordan, AR - 725192432 |
Business Phone Number: | 8704040388 |
Business Fax Number: | |
Mailing Address: | Po Box 2432, JORDAN |
State: | AR |
Postal Code: | 725192432 |
Phone Number: | 8704040388 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2010 |
NPI Last Update Date: | 11/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A003424 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |