Individual
GRANT KEITH LOFTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFNP
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
(601) 364-1425
Mailing address
709 CHARLIE DIXON RD, BRAXTON, MS 39044-9315
(601) 362-4471
(601) 364-1425
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
R587052
MS
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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