Healthcare Provider Details

I. General information

NPI: 1871245381
Provider Name (Legal Business Name): AMY LANELL LOWERY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W KING ST
KINGS MOUNTAIN NC
28086-3393
US

IV. Provider business mailing address

407 W KING ST
KINGS MOUNTAIN NC
28086-3393
US

V. Phone/Fax

Practice location:
  • Phone: 980-829-8186
  • Fax:
Mailing address:
  • Phone: 704-730-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5015810
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: