Basic Information
| Provider Information | |||||||||
| NPI: | 1528303559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDOWELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 SCHENCK ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044809344 | ||||||||
| FaxNumber: | 7044843260 | ||||||||
| Practice Location | |||||||||
| Address1: | 5009 FALLSTON RD | ||||||||
| Address2: | |||||||||
| City: | LAWNDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280909585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044809344 | ||||||||
| FaxNumber: | 7045385803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5005981 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 8966816 | 05 | NC | MEDICAID |