Provider Demographics
NPI:1386452407
Name:LOOPER, LUCY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:LOOPER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-752-8548
Mailing Address - Fax:
Practice Address - Street 1:727 EAST BRUNDAGE LANE
Practice Address - Street 2:SUITE I
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8280
Practice Address - Country:US
Practice Address - Phone:307-752-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY55836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health