Individual
SHANNON HANEY LOFTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
502 BROAD ST, COLUMBIA, MS 39429-3037
(601) 736-8282
(601) 736-8333
Mailing address
1065 E BROAD ST, MONTICELLO, MS 39654-7703
(601) 587-4051
(601) 587-0306
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
901706
MS
363LF0000X
Family Nurse Practitioner
Primary
901706
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01808562
—
MS
Enumeration date
06/15/2016
Last updated
12/04/2020
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