Provider Demographics
NPI:1245488410
Name:COWSAR, PAUL EDMOND (FNP/ACNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDMOND
Last Name:COWSAR
Suffix:
Gender:M
Credentials:FNP/ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2420
Mailing Address - Country:US
Mailing Address - Phone:304-523-1142
Mailing Address - Fax:
Practice Address - Street 1:1415 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2420
Practice Address - Country:US
Practice Address - Phone:304-523-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN96666-NP-C363LA2100X, 363LF0000X
KY3005882363LF0000X, 363L00000X, 363LA2100X
WVAPRN96666363LF0000X
SC20876363LF0000X, 363LA2100X
OHAPRN.CNP.020182363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197624Medicaid
WV1245488410Medicaid
KY7100106650Medicaid