Provider Demographics
NPI:1528267556
Name:LOWERY, MIRANDA A (RD)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:A
Last Name:LOWERY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8259
Mailing Address - Country:US
Mailing Address - Phone:931-393-3000
Mailing Address - Fax:931-461-4684
Practice Address - Street 1:1801 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8259
Practice Address - Country:US
Practice Address - Phone:931-393-3000
Practice Address - Fax:931-461-4684
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered