Provider Demographics
NPI:1427368349
Name:OWENS, CONNIE
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 GOAT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4843
Mailing Address - Country:US
Mailing Address - Phone:830-895-0747
Mailing Address - Fax:830-895-0748
Practice Address - Street 1:1610 GOAT CREEK RD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4843
Practice Address - Country:US
Practice Address - Phone:830-895-0747
Practice Address - Fax:830-895-0748
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0151763747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant