Provider Demographics
NPI:1114199304
Name:LOWE, JONATHAN ANDREW (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:LOWE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 SIERRA DR E
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-5050
Mailing Address - Country:US
Mailing Address - Phone:203-215-9957
Mailing Address - Fax:
Practice Address - Street 1:10978 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0433
Practice Address - Country:US
Practice Address - Phone:305-821-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT081141163WP0809X
CT003960363LP0808X
CA95014582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult