Provider Demographics
NPI:1598765612
Name:LOWERY, JENNIE K (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:K
Last Name:LOWERY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:SUITE 331
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6339
Mailing Address - Country:US
Mailing Address - Phone:850-484-6500
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9181387363L00000X
AL1-133219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891009510Medicaid
FL304327400Medicaid
FLS59330Medicare UPIN
AL891009510Medicaid