Provider Demographics
NPI:1992009310
Name:COWHERD, MARY JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:COWHERD
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 1:800 ROSE ST # G-100
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0294
Mailing Address - Country:US
Mailing Address - Phone:859-323-0295
Mailing Address - Fax:859-323-1256
Practice Address - Street 1:800 ROSE ST # G-100
Practice Address - Street 2:UNIVERSITY OF KENTUCKY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0294
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:859-323-1256
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100147970Medicaid
KYK015550Medicare PIN