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General NPI Number Information
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NPI Number | 1538285077
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Entity Type | Individual
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Provider Name | MAKISHA TAMSEN OWENS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
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City | FORT LIBERTY
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State | NC
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Zip | 28310-1013
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Country | US
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Telephone | 109-079-7189
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Fax | 910-432-5812
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Provider Business Mailing Address
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Address Line | 1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-907-9718
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-06408
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 01227
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License Number State | WV
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