Provider Demographics
NPI:1386038099
Name:OWENS, MYOSHI (NP)
Entity type:Individual
Prefix:
First Name:MYOSHI
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BUFORD HWY APT 2118
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7795
Mailing Address - Country:US
Mailing Address - Phone:704-807-7798
Mailing Address - Fax:
Practice Address - Street 1:6300 JIMMY CARTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2347
Practice Address - Country:US
Practice Address - Phone:770-280-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007801363L00000X, 363LF0000X
CA95002291363LF0000X
GARN269731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386038099Medicaid
SCNP4026Medicaid
NC1386038099Medicaid
NCNC0897DMedicare PIN
NCNC0897BMedicare UPIN
NCNC0897CMedicare UPIN
NCNC0897EMedicare UPIN