Provider Demographics
NPI:1730150681
Name:LOONEY, CAROL A (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:LOONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-0729
Mailing Address - Country:US
Mailing Address - Phone:276-496-4433
Mailing Address - Fax:276-496-5923
Practice Address - Street 1:308 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-3112
Practice Address - Country:US
Practice Address - Phone:227-649-6443
Practice Address - Fax:276-496-5923
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024059091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily