Provider Demographics
NPI:1467093815
Name:MOWREY, COLLEEN GAYE (RPSGT, CCHS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:GAYE
Last Name:MOWREY
Suffix:
Gender:F
Credentials:RPSGT, CCHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 E CHEROKEE GLN
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2802
Mailing Address - Country:US
Mailing Address - Phone:601-405-5061
Mailing Address - Fax:
Practice Address - Street 1:1114 E CHEROKEE GLN
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2802
Practice Address - Country:US
Practice Address - Phone:601-405-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19909225500000X
MS390225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist