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NPI Code Detail

MEDICARE: JONATHAN JAMES MOWRY

MEDICARE: JONATHAN JAMES MOWRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1164261848
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN JAMES MOWRY
Provider Business Mailing Address
First Line : 1409 NORTH FORK HWY
Second Line :
City : PETERSBURG
State : WV
Zip : 26847
Country : US
Telephone Number : 304-851-2645
Fax Number :
Provider Business Practice Location Address
First Line : 1409 NORTH FORK HWY
Second Line :
City : PETERSBURG
State : WV
Zip : 26847
Country : US
Telephone Number : 304-851-2645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2024
Last Update Date : 05/22/2024

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Directions to “ JONATHAN JAMES MOWRY ” Practice Location

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