Healthcare Provider Details

I. General information

NPI: 1831445329
Provider Name (Legal Business Name): MISHELLE LYNN MOWRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

IV. Provider business mailing address

2260 MORSE RD
COLUMBUS OH
43229-5858
US

V. Phone/Fax

Practice location:
  • Phone: 614-702-7899
  • Fax: 614-706-1570
Mailing address:
  • Phone: 614-702-7899
  • Fax: 614-706-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13612-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: