Provider Demographics
NPI:1154882710
Name:LOPER, JOHN R (CRNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:LOPER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 AL HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AL
Mailing Address - Zip Code:35096-6508
Mailing Address - Country:US
Mailing Address - Phone:251-716-6711
Mailing Address - Fax:
Practice Address - Street 1:3312 HENRY RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6344
Practice Address - Country:US
Practice Address - Phone:256-241-2671
Practice Address - Fax:256-241-2676
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-128727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily