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General NPI Number Information
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NPI Number | 1285528844
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Entity Type | Individual
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Provider Name | SYDNIE NICOLE NOWLEN LPTA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 5140 GALAXIE DR
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City | JACKSON
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State | MS
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Zip | 39206-4335
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Country | US
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Telephone | 769-216-3288
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Fax | 601-510-9012
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Provider Business Mailing Address
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Address Line | PO BOX 75
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City | MADISON
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State | MS
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Zip | 39130-0075
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Country | US
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Telephone | 769-216-3288
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Fax | 601-510-9012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA7601
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License Number State | MS
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