Provider Demographics
NPI:1336182039
Name:LOWN, KENNETH J A (ARNP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J A
Last Name:LOWN
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12945 SPRING RAIN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5201
Mailing Address - Country:US
Mailing Address - Phone:904-501-0216
Mailing Address - Fax:
Practice Address - Street 1:1679 EAGLE HARBOR PKWY STE B
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4816
Practice Address - Country:US
Practice Address - Phone:904-264-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267410163WP2201X, 363LP0200X
PASP007282163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308659300Medicaid
GA512593957AMedicaid