Healthcare Provider Details

I. General information

NPI: 1831996099
Provider Name (Legal Business Name): BREANNA RENA LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 W HIGHWAY 80
NANCY KY
42544-9053
US

IV. Provider business mailing address

39 BRADLEY ST
STANFORD KY
40484-6529
US

V. Phone/Fax

Practice location:
  • Phone: 606-288-0013
  • Fax: 606-288-9600
Mailing address:
  • Phone: 606-273-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1177497
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4046228
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: