Provider Demographics
NPI:1952158263
Name:LOWERY, MIRIAM SEGURA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:SEGURA
Last Name:LOWERY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 KARABETH LN
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-4119
Mailing Address - Country:US
Mailing Address - Phone:903-241-2999
Mailing Address - Fax:
Practice Address - Street 1:3118 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2941
Practice Address - Country:US
Practice Address - Phone:903-200-1433
Practice Address - Fax:903-405-4047
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1159437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health