1508387531 NPI number — JEFFERY NONE LOWERY SPEECH PATHOLOGIST

Table of content: JEFFERY NONE LOWERY SPEECH PATHOLOGIST (NPI 1508387531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508387531 NPI number — JEFFERY NONE LOWERY SPEECH PATHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWERY
Provider First Name:
JEFFERY
Provider Middle Name:
NONE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH PATHOLOGIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508387531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENANSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28349-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-372-9300
Provider Business Mailing Address Fax Number:
910-372-9302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VIDANT DUPLIN REHABILLITATION
Provider Second Line Business Practice Location Address:
514 S. MAIN STREET
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-372-9300
Provider Business Practice Location Address Fax Number:
910-372-9302
Provider Enumeration Date:
06/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  5691 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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