Provider Demographics
NPI:1588491096
Name:OWENS, JEFFREY BRIAN (PMHNP, RN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRIAN
Last Name:OWENS
Suffix:
Gender:M
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 AVENUE C
Mailing Address - Street 2:APT MB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009
Mailing Address - Country:US
Mailing Address - Phone:901-674-6737
Mailing Address - Fax:
Practice Address - Street 1:245 AVENUE C
Practice Address - Street 2:APT MB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2516
Practice Address - Country:US
Practice Address - Phone:901-674-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403826-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health