Healthcare Provider Details

I. General information

NPI: 1346437407
Provider Name (Legal Business Name): LISA GAYLE LOWE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 106TH ST SUITE 235
OVERLAND PARK KS
66215-2305
US

IV. Provider business mailing address

PO BOX 741331
ATLANTA GA
30374-1331
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-8686
  • Fax: 913-338-1311
Mailing address:
  • Phone: 913-469-0503
  • Fax: 913-469-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45914
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: