Provider Demographics
NPI:1275800344
Name:LOWERY, ALICIA DIANE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DIANE
Last Name:LOWERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-0506
Mailing Address - Country:US
Mailing Address - Phone:318-239-4860
Mailing Address - Fax:805-295-4715
Practice Address - Street 1:10600 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-5105
Practice Address - Country:US
Practice Address - Phone:318-239-4860
Practice Address - Fax:805-295-4715
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208047163WX0200X, 364SX0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203375501Medicaid
LA2515756Medicaid
TX29457010Medicaid
TX203375501Medicaid