Provider Demographics
NPI:1063026029
Name:LOWERY, TIFFANY LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:LOWERY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:2903 CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:662-549-4999
Mailing Address - Fax:
Practice Address - Street 1:1513 E PRESIDIO ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6735
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-2939
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2022-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1011090207Q00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology