Healthcare Provider Details

I. General information

NPI: 1245325182
Provider Name (Legal Business Name): CHERRIE L. COWAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/07/2023
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 CAMDEN AVE
PARKERSBURG WV
26101-5652
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 304-917-3733
  • Fax: 304-917-3750
Mailing address:
  • Phone: 304-275-3301
  • Fax: 304-275-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26653
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: