Provider Demographics
NPI:1275764847
Name:COWHERD, CONSTANCE F (ANP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:F
Last Name:COWHERD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 OLD RICEVILLE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3074
Mailing Address - Country:US
Mailing Address - Phone:423-744-8755
Mailing Address - Fax:423-744-8568
Practice Address - Street 1:421 OLD RICEVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3074
Practice Address - Country:US
Practice Address - Phone:423-744-8755
Practice Address - Fax:423-744-8568
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008463363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521976Medicaid