Provider Demographics
NPI:1740407832
Name:LOWERY, SYDNEY H (LPN)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:H
Last Name:LOWERY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1258
Mailing Address - Country:US
Mailing Address - Phone:601-649-0070
Mailing Address - Fax:601-649-0070
Practice Address - Street 1:904 STATE ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1258
Practice Address - Country:US
Practice Address - Phone:601-649-0070
Practice Address - Fax:601-649-0070
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP195987164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770216Medicaid