Provider Demographics
NPI:1023269487
Name:LOOP, CONNIE K (RNFA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:K
Last Name:LOOP
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:AR
Mailing Address - Zip Code:71831-0035
Mailing Address - Country:US
Mailing Address - Phone:870-200-1552
Mailing Address - Fax:870-983-2247
Practice Address - Street 1:7601 CHURCHILL WAY APT 529
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1956
Practice Address - Country:US
Practice Address - Phone:870-200-1552
Practice Address - Fax:870-983-2247
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653305163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant