Provider Demographics
NPI:1528303559
Name:MCDOWELL, DAVID R JR (ANP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:MCDOWELL
Suffix:JR
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SCHENCK ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3934
Mailing Address - Country:US
Mailing Address - Phone:704-480-9344
Mailing Address - Fax:704-484-3260
Practice Address - Street 1:5009 FALLSTON RD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090-9585
Practice Address - Country:US
Practice Address - Phone:704-480-9344
Practice Address - Fax:704-538-5803
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005981363L00000X
TNRN0000184377163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8966816Medicaid
NCNCF401AMedicare PIN
NCNCF401BMedicare PIN