Provider Demographics
NPI:1649416488
Name:MARTI M COWHERD
Entity Type:Organization
Organization Name:MARTI M COWHERD
Other - Org Name:FAMILY PRACTICE OF RAY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COWHERD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP,PNP-BC
Authorized Official - Phone:816-776-6933
Mailing Address - Street 1:701 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2206
Mailing Address - Country:US
Mailing Address - Phone:816-776-6933
Mailing Address - Fax:816-776-2928
Practice Address - Street 1:701 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2206
Practice Address - Country:US
Practice Address - Phone:816-776-6933
Practice Address - Fax:816-776-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504691403Medicaid