Provider Demographics
NPI:1902681356
Name:LOOS, KEVIN E (MSN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:LOOS
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6643
Mailing Address - Country:US
Mailing Address - Phone:423-557-9572
Mailing Address - Fax:
Practice Address - Street 1:511 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6643
Practice Address - Country:US
Practice Address - Phone:423-557-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000212462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse