Healthcare Provider Details

I. General information

NPI: 1821694977
Provider Name (Legal Business Name): MATTHEW LEE MCCOWAN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 E 29TH AVE
SPOKANE WA
99223-4811
US

IV. Provider business mailing address

5521 REDHAWK DR
NEW PORT RICHEY FL
34655-1234
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 509-227-7070
Mailing address:
  • Phone: 727-666-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: