Provider Demographics
NPI:1457819211
Name:LOWDER, MISTY RENEA
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:RENEA
Last Name:LOWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-1721
Mailing Address - Country:US
Mailing Address - Phone:405-887-2837
Mailing Address - Fax:
Practice Address - Street 1:1205 N COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-1721
Practice Address - Country:US
Practice Address - Phone:405-887-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist