Provider Demographics
NPI:1902056138
Name:COWGER, JAMES EDWARD JR (APN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:COWGER
Suffix:JR
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:929 STACEY BURK DR
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-3241
Mailing Address - Country:US
Mailing Address - Phone:618-662-2191
Mailing Address - Fax:618-662-8090
Practice Address - Street 1:929 STACEY BURK DR
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-3241
Practice Address - Country:US
Practice Address - Phone:618-662-2191
Practice Address - Fax:618-662-8090
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000593533146L00000X
IL041.336590163W00000X
MO2007005874163W00000X
IL209.009553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163W00000XNursing Service ProvidersRegistered Nurse