Provider Demographics
NPI:1386038099
Name:OWENS, MYOSHI (NP)
Entity type:Individual
Prefix:
First Name:MYOSHI
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:704-627-8365
Mailing Address - Fax:
Practice Address - Street 1:1530 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8313
Practice Address - Country:US
Practice Address - Phone:704-627-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007801363LF0000X, 363L00000X
GARN269731363LF0000X
CA95002291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386038099Medicaid
SCNP4026Medicaid
NC1386038099Medicaid
NCNC0897DMedicare PIN
NCNC0897BMedicare UPIN
NCNC0897CMedicare UPIN
NCNC0897EMedicare UPIN