Provider Demographics
NPI:1730444001
Name:ROWSEY, MIRANDA R (FNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:R
Last Name:ROWSEY
Suffix:
Gender:F
Credentials:FNP
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 1000
Mailing Address - Street 2:DEPT 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-266-6445
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-5800
Practice Address - Fax:541-706-5800
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530812Medicaid
TN6005189OtherBCBS
MS03188711Medicaid
TN6002378OtherBCBS
AR195236758Medicaid
TN1530812Medicaid
TN103I507124Medicare PIN