MEDICARE: MYOSHI OWENS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5007801	NC
2	363L00000X	Nurse Practitioner	5007801	NC
3	363LF0000X	Family Nurse Practitioner	RN269731	GA
4	363LF0000X	Family Nurse Practitioner	95002291	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386038099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYOSHI OWENS NP

Provider Business Mailing Address
First Line	:	PO BOX 601843
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1843
Country	:	US
Telephone Number	:	704-627-8365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 S PROVIDENCE RD
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-8313
Country	:	US
Telephone Number	:	704-627-8365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	12/17/2025

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