Provider Demographics
NPI:1871043414
Name:COWSERT, JAYNA LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:LYNNE
Last Name:COWSERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAYNA
Other - Middle Name:
Other - Last Name:SPIVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3411 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6394
Mailing Address - Country:US
Mailing Address - Phone:618-997-2161
Mailing Address - Fax:618-997-2420
Practice Address - Street 1:3411 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6394
Practice Address - Country:US
Practice Address - Phone:618-997-2161
Practice Address - Fax:618-997-2420
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant