1700212081 NPI number — MRS. KAREN ANN GRIM LOWTHER MS

Table of content: MRS. KAREN ANN GRIM LOWTHER MS (NPI 1700212081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700212081 NPI number — MRS. KAREN ANN GRIM LOWTHER MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWTHER
Provider First Name:
KAREN ANN
Provider Middle Name:
GRIM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

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:
1700212081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 SW PARKRIDGE BLVD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73505-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-530-6606
Provider Business Mailing Address Fax Number:
844-766-7644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 NW 2ND ST # 191
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73507-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-288-0069
Provider Business Practice Location Address Fax Number:
844-766-7644
Provider Enumeration Date:
09/18/2013

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200517880B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200517880A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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