Healthcare Provider Details

I. General information

NPI: 1437121159
Provider Name (Legal Business Name): PATRICIA ANNE STOWE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 DOGWOOD ST W
WARWICK GA
31796
US

IV. Provider business mailing address

PO BOX 5007
CORDELE GA
31010
US

V. Phone/Fax

Practice location:
  • Phone: 229-535-4567
  • Fax: 229-535-6556
Mailing address:
  • Phone: 229-271-4656
  • Fax: 229-271-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN022471
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: