Healthcare Provider Details

I. General information

NPI: 1730652900
Provider Name (Legal Business Name): KATHERINE MARIA OWENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CHENOWETH DR
BRIDGEPORT WV
26330-1887
US

IV. Provider business mailing address

635 PENNSYLVANIA AVE
BRIDGEPORT WV
26330-1234
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-3318
  • Fax:
Mailing address:
  • Phone: 304-672-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number88894
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: