Provider Demographics
NPI:1912150822
Name:LOWRY, KELLIE LYNN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:LOWRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LYNN
Other - Last Name:DORKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 FRANCISCO ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2122
Mailing Address - Country:US
Mailing Address - Phone:415-395-9895
Mailing Address - Fax:415-395-9897
Practice Address - Street 1:55 FRANCISCO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2122
Practice Address - Country:US
Practice Address - Phone:415-395-9895
Practice Address - Fax:415-395-9897
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005371363A00000X
PAMA-053827363A00000X
CAPA22268363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant