Provider Demographics
NPI:1225885064
Name:OWEN, ASHETYN TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:ASHETYN
Middle Name:TAYLOR
Last Name:OWEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 SISKEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3225
Mailing Address - Country:US
Mailing Address - Phone:980-318-7743
Mailing Address - Fax:
Practice Address - Street 1:3326 SISKEY PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3225
Practice Address - Country:US
Practice Address - Phone:704-997-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001015129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant