Provider Demographics
NPI:1538503511
Name:COWAN, TRACEY LYNETTE
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNETTE
Last Name:COWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 COUNTY ROAD 534
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-9113
Mailing Address - Country:US
Mailing Address - Phone:662-587-2412
Mailing Address - Fax:
Practice Address - Street 1:21 COUNTY ROAD 534
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-9113
Practice Address - Country:US
Practice Address - Phone:662-587-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker