Provider Demographics
NPI:1932215019
Name:COWAN, TERRI B (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:B
Last Name:COWAN
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 604093
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4093
Mailing Address - Country:US
Mailing Address - Phone:843-454-0245
Mailing Address - Fax:843-479-7873
Practice Address - Street 1:957 CHERAW ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2420
Practice Address - Country:US
Practice Address - Phone:843-454-0245
Practice Address - Fax:843-479-7873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC101754363AM0700X
SC348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical