Provider Demographics
NPI:1407160476
Name:LOFLEY, KENT JEREL (DO)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:JEREL
Last Name:LOFLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HAZEL PATH STE 5
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3888
Mailing Address - Country:US
Mailing Address - Phone:615-266-6465
Mailing Address - Fax:615-991-0905
Practice Address - Street 1:109 HAZEL PATH STE 5
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3888
Practice Address - Country:US
Practice Address - Phone:615-266-6465
Practice Address - Fax:615-991-0905
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4530207Q00000X
UT10828844-1204207Q00000X
WY11744C207Q00000X
MN64515207Q00000X
AZ007796207Q00000X
IL036147333207Q00000X
NVCL0031207Q00000X
WAOP60896839207Q00000X
CA20A16859207Q00000X
IADO-05339207Q00000X
SD11384207Q00000X
CODR.0050812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4530OtherTENNESSEE BOARD OF OSTEOPATHIC EXAMINATION
CO50812OtherCOLO LICENSE
CO87220059Medicaid