Provider Demographics
NPI:1811242621
Name:DOWLER, JORDEN BURGETT (PA-C)
Entity type:Individual
Prefix:
First Name:JORDEN
Middle Name:BURGETT
Last Name:DOWLER
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:980-212-2610
Mailing Address - Fax:980-212-2611
Practice Address - Street 1:1802 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3915
Practice Address - Country:US
Practice Address - Phone:980-212-2610
Practice Address - Fax:980-212-2611
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002871363AM0700X
NC0010-05889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811242621Medicaid
NC1811242621Medicaid