Provider Demographics
NPI:1013517796
Name:GOWER, KIFANY M (PA-C)
Entity Type:Individual
Prefix:
First Name:KIFANY
Middle Name:M
Last Name:GOWER
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 1:14 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-3185
Mailing Address - Country:US
Mailing Address - Phone:570-851-7243
Mailing Address - Fax:
Practice Address - Street 1:14 KELLY ST
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-3185
Practice Address - Country:US
Practice Address - Phone:570-851-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant