1538285077 NPI number — MRS. MAKISHA TAMSEN OWENS PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538285077 NPI number — MRS. MAKISHA TAMSEN OWENS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWENS
Provider First Name:
MAKISHA
Provider Middle Name:
TAMSEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538285077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LIBERTY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28310-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-907-9718
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
109-079-7189
Provider Business Practice Location Address Fax Number:
910-432-5812
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  01227 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: 0010-06408 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538285077 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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