=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306311311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY W LOWRY APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2018
-----------------------------------------------------
Last Update Date | 06/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11673 JOLLYVILLE ROAD BLDG B #202
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-342-7979
-----------------------------------------------------
Fax | 512-637-2596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10311 KARIBA CV
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78726-1396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-663-3646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | AP138563
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP138563
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------