Healthcare Provider Details

I. General information

NPI: 1144293879
Provider Name (Legal Business Name): KENNETH W LOWRANCE MS, RN, CS, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S AVENUE T
CLIFTON TX
76634-1855
US

IV. Provider business mailing address

PO BOX 72
CLIFTON TX
76634-0072
US

V. Phone/Fax

Practice location:
  • Phone: 254-675-8621
  • Fax: 254-675-2254
Mailing address:
  • Phone: 254-675-8621
  • Fax: 254-675-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: