Provider Demographics
NPI:1326817453
Name:LOWTHER, TARRAH JAYDE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TARRAH
Middle Name:JAYDE
Last Name:LOWTHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TARRAH
Other - Middle Name:JAYDE
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 GERMANTOWN CT STE 300
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4258
Mailing Address - Country:US
Mailing Address - Phone:901-737-4665
Mailing Address - Fax:901-328-1355
Practice Address - Street 1:7668 AIRWAYS BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-6950
Practice Address - Fax:662-349-6634
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906427363LF0000X
MS910463163WE0003X
TN35363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency