Provider Demographics
NPI:1407351877
Name:OWENS, MICAELA
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:OWENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-1787
Mailing Address - Fax:
Practice Address - Street 1:2520 VALLEY DRIVE
Practice Address - Street 2:SUIRE G12
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-675-1484
Practice Address - Fax:304-675-1496
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT0185402084N0400X
WV40902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology