Provider Demographics
NPI:1093293177
Name:WILSON, DEEANNA LOWERY (PA)
Entity Type:Individual
Prefix:
First Name:DEEANNA
Middle Name:LOWERY
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEEANNA
Other - Middle Name:ELISABETH
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:183 LEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6213
Mailing Address - Country:US
Mailing Address - Phone:828-837-4712
Mailing Address - Fax:
Practice Address - Street 1:183 LEDFORD ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6213
Practice Address - Country:US
Practice Address - Phone:828-837-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant