Healthcare Provider Details

I. General information

NPI: 1194946434
Provider Name (Legal Business Name): MRS. BRENDA JO JOWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N 4TH ST
MERKEL TX
79536-3062
US

IV. Provider business mailing address

1502 N 4TH ST
MERKEL TX
79536-3062
US

V. Phone/Fax

Practice location:
  • Phone: 325-928-4249
  • Fax:
Mailing address:
  • Phone: 325-928-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number117167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: