Provider Demographics
NPI:1245325182
Name:COWAN, CHERRIE L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHERRIE
Middle Name:L
Last Name:COWAN
Suffix:
Gender:F
Credentials:FNP-BC
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 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:2610 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5652
Practice Address - Country:US
Practice Address - Phone:304-917-3733
Practice Address - Fax:304-917-3750
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26653363L00000X
OH12967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANP76911OtherPROVIDER ID NUMBER
WV7102017000Medicaid
OH2198492Medicaid
WV26653OtherSTATE NURSING LICENSE #
OHRN 215226OtherOHIO NURSING LICENSE #
WVRXA1063OtherWV PRESCRIPTIVE AUTH #
WVRXA1063OtherWV PRESCRIPTIVE AUTH #
WVNP00609Medicare PIN
WV26653OtherSTATE NURSING LICENSE #
WVRXA1063OtherWV PRESCRIPTIVE AUTH #