Basic Information
Provider Information | |||||||||
NPI: | 1245325182 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COWAN | ||||||||
FirstName: | CHERRIE | ||||||||
MiddleName: | L. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 609 | ||||||||
Address2: |   | ||||||||
City: | ELIZABETH | ||||||||
State: | WV | ||||||||
PostalCode: | 261430609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042753301 | ||||||||
FaxNumber: | 3042754798 | ||||||||
Practice Location | |||||||||
Address1: | 2610 CAMDEN AVE | ||||||||
Address2: |   | ||||||||
City: | PARKERSBURG | ||||||||
State: | WV | ||||||||
PostalCode: | 261015652 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3049173733 | ||||||||
FaxNumber: | 3049173750 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2006 | ||||||||
LastUpdateDate: | 04/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/02/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26653 | WV | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363L00000X | 12967 | OH | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | NP76911 | 01 | WA | PROVIDER ID NUMBER | OTHER | 7102017000 | 05 | WV |   | MEDICAID | 2198492 | 05 | OH |   | MEDICAID | 26653 | 01 | WV | STATE NURSING LICENSE # | OTHER | MCO169614 | 01 | WV | DEA NUMBER | OTHER | RN 215226 | 01 | OH | OHIO NURSING LICENSE # | OTHER | RXA1063 | 01 | WV | WV PRESCRIPTIVE AUTH # | OTHER |