Provider Demographics
NPI:1629147665
Name:MCGOWAN, SHANNON ANN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:ANN
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 HUFFMAN MILL RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-227-2761
Mailing Address - Fax:336-585-0688
Practice Address - Street 1:1236 HUFFMAN MILL RD STE 1300
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-227-2761
Practice Address - Fax:336-585-0688
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102950363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS79482Medicare UPIN