Provider Demographics
NPI:1346437407
Name:LOWE, LISA GAYLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GAYLE
Last Name:LOWE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-492-8686
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2012-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS45914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346437407Medicaid
KS100325950BMedicaid
KSR57000001Medicare PIN
KS100325950BMedicaid