Provider Demographics
NPI:1669818043
Name:LOWE, AYISHIA KEVETA
Entity Type:Individual
Prefix:
First Name:AYISHIA
Middle Name:KEVETA
Last Name:LOWE
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 1:50 CAMI CV
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6092
Mailing Address - Country:US
Mailing Address - Phone:901-825-7408
Mailing Address - Fax:
Practice Address - Street 1:5277 INTEGRITY DR
Practice Address - Street 2:BLDG S771
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230297363LF0000X
TX2354363LF0000X
TN17329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily