Provider Demographics
NPI:1609476456
Name:LOWE, KERI L (NP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:L
Last Name:LOWE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4264
Mailing Address - Country:US
Mailing Address - Phone:765-289-5006
Mailing Address - Fax:765-741-4658
Practice Address - Street 1:4000 W WOODWAY DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4264
Practice Address - Country:US
Practice Address - Phone:765-289-5006
Practice Address - Fax:765-741-4658
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010942A363L00000X
IN28207284A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner