Provider Demographics
NPI:1508079476
Name:LOWERY, NATASHA JACOBS (PA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:JACOBS
Last Name:LOWERY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:FAYE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12745 ROSINDALE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-9722
Mailing Address - Country:US
Mailing Address - Phone:910-827-1044
Mailing Address - Fax:
Practice Address - Street 1:736 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472
Practice Address - Country:US
Practice Address - Phone:910-207-6597
Practice Address - Fax:910-207-6599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant