Provider Demographics
NPI:1801140652
Name:OWENS, THELMA JANE (NP-C)
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:JANE
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP-C
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 438
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0438
Mailing Address - Country:US
Mailing Address - Phone:870-297-3726
Mailing Address - Fax:870-297-4161
Practice Address - Street 1:61 GRASSE ST.
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-0000
Practice Address - Country:US
Practice Address - Phone:870-297-3726
Practice Address - Fax:870-297-4161
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA003785OtherLICENSE NUMBER