Healthcare Provider Details

I. General information

NPI: 1952675043
Provider Name (Legal Business Name): CHARISSA KIRKLAND LOWE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 MAIN STREET SUITE C LTC HEALTH SOLUTIONS
COLUMBIA SC
29201-2818
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-451-6133
  • Fax: 803-726-2210
Mailing address:
  • Phone: 803-726-2350
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17716
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: