Basic Information
Provider Information
NPI: 1962600312
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOWRY
FirstName: STEPHANIE
MiddleName: L.
NamePrefix: MRS.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 550
Address2:  
City: LOWELL
State: AR
PostalCode: 727450550
CountryCode: US
TelephoneNumber: 4794637775
FaxNumber: 4794637187
Practice Location
Address1: 813 FOUNDERS PARK DR.
Address2: SUITE 201
City: SPRINGDALE
State: AR
PostalCode: 72762
CountryCode: US
TelephoneNumber: 4794635466
FaxNumber: 4794635463
Other Information
ProviderEnumerationDate: 07/06/2007
LastUpdateDate: 10/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QA0000XE-5944ARY Allopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine

No ID Information.


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