Provider Demographics
NPI:1154326577
Name:COWAN, CATHERINE ELISKA (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELISKA
Last Name:COWAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1001 12TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3926
Practice Address - Country:US
Practice Address - Phone:817-336-1189
Practice Address - Fax:817-877-5665
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162289602Medicaid
TX162289605Medicaid
TX162289603Medicaid
TX162289606Medicaid
P99959Medicare UPIN
TX162289606Medicaid
TX8B8880Medicare PIN
TX162289603Medicaid
TX162289602Medicaid
TX8B8978Medicare PIN