Provider Demographics
NPI:1497055826
Name:COWART, AMY NICOLE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:COWART
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 1:1233 TRACY LYNN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-6269
Mailing Address - Country:US
Mailing Address - Phone:325-232-8728
Mailing Address - Fax:325-232-8729
Practice Address - Street 1:1233 TRACY LYNN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-6249
Practice Address - Country:US
Practice Address - Phone:325-232-8728
Practice Address - Fax:325-232-8729
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies