Provider Demographics
NPI:1376591305
Name:LOW, LISA KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KATHLEEN
Last Name:LOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:KATHLEEN WELSH
Other - Last Name:LOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3101 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4900
Mailing Address - Country:US
Mailing Address - Phone:479-986-6090
Mailing Address - Fax:479-986-6250
Practice Address - Street 1:3101 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4900
Practice Address - Country:US
Practice Address - Phone:479-986-6090
Practice Address - Fax:479-986-6250
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135785001Medicaid
AR5L017Medicare PIN
ARG01938Medicare UPIN