Basic Information
| Provider Information | |||||||||
| NPI: | 1194169078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOONEY | ||||||||
| FirstName: | KENDREA | ||||||||
| MiddleName: | DIJUANNA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 458 USHER RD | ||||||||
| Address2: | |||||||||
| City: | HARVEST | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357498222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052679974 | ||||||||
| FaxNumber: | 2565198327 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 GOVERNORS DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358012700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562651000 | ||||||||
| FaxNumber: | 2565198327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 1-106127 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.