MEDICARE: KENDRA LYNN LOWING P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601003364

General Provider Information

NPI Number	:	1710951488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LYNN LOWING P.A.

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6795
Fax Number	:	616-486-6675

Provider Business Practice Location Address
First Line	:	4100 LAKE DR SE
Second Line	:	SUITE 200
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8292
Country	:	US
Telephone Number	:	616-267-8244
Fax Number	:	616-267-7272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	02/25/2021

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