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General NPI Number Information
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NPI Number | 1750771390
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Entity Type | Individual
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Provider Name | KORY LOWE P.A.
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Gender | Male
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 5050 POWDERHOUSE RD
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City | CHEYENNE
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State | WY
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Zip | 82009-4800
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Country | US
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Telephone | 307-634-1311
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Fax | 307-996-9296
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Provider Business Mailing Address
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Address Line | 5050 POWDERHOUSE RD
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City | CHEYENNE
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State | WY
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Zip | 82009-4800
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Country | US
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Telephone | 307-634-1311
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Fax | 307-996-9296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA.0007485
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA770
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License Number State | WY
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