Provider Demographics
NPI:1083442958
Name:LOWERY, MARY R (PERSONAL CARE ASSIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:LOWERY
Suffix:
Gender:F
Credentials:PERSONAL CARE ASSIST
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KINGDOM EXCELLENT CA
Mailing Address - Street 1:1207 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4445
Mailing Address - Country:US
Mailing Address - Phone:910-703-9978
Mailing Address - Fax:
Practice Address - Street 1:1207 NORTH ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4445
Practice Address - Country:US
Practice Address - Phone:910-703-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant