Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1011090 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1011090 | TX |
NPI | 1063026029 |
---|---|
Provider Name | Mrs. Tiffany Lynn Lowery |
First Address | Grand Prairie, TX 75052 |
Second Address | Fort Worth, TX 76102-6735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2020 |
Last Update Date | 23/11/2021 |