Provider Demographics
NPI:1538285077
Name:OWENS, MAKISHA TAMSEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MAKISHA
Middle Name:TAMSEN
Last Name:OWENS
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 1:1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-9718
Mailing Address - Fax:
Practice Address - Street 1:1-2539 R MILLER STREET PUBLIC HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-1013
Practice Address - Country:US
Practice Address - Phone:109-079-7189
Practice Address - Fax:910-432-5812
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06408363AM0700X
WV01227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1538285077Medicaid
WVRA2032051Medicare PIN
WVWV1395B278Medicare PIN