Provider Demographics
NPI:1942967500
Name:MCCOWN, CELINA D (NP)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:D
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CELINA
Other - Middle Name:
Other - Last Name:PLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-0587
Mailing Address - Country:US
Mailing Address - Phone:830-672-8502
Mailing Address - Fax:830-672-3035
Practice Address - Street 1:1110 N SARAH DEWITT DR
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3311
Practice Address - Country:US
Practice Address - Phone:830-672-8502
Practice Address - Fax:830-672-3035
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059074363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1059074OtherAPRN-CNP
TX1942967500Medicaid