Provider Demographics
NPI:1346982238
Name:COWAN, TRICIA LYNN (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:COWAN
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9461 KNAPPEN HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6917
Mailing Address - Country:US
Mailing Address - Phone:507-380-2446
Mailing Address - Fax:
Practice Address - Street 1:24760 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671
Practice Address - Country:US
Practice Address - Phone:218-679-0168
Practice Address - Fax:218-679-3912
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8478363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health