Provider Demographics
NPI:1427321918
Name:COWELL, JACQUELINE M (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:COWELL
Suffix:
Gender:F
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 1:1911 S 17TH ST
Mailing Address - Street 2:SUITE 130A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6663
Mailing Address - Country:US
Mailing Address - Phone:910-790-7840
Mailing Address - Fax:
Practice Address - Street 1:1911 S 17TH ST
Practice Address - Street 2:SUITE 130A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6663
Practice Address - Country:US
Practice Address - Phone:910-790-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical