Provider Demographics
NPI:1699346023
Name:COWAN, HEATHER (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3780
Mailing Address - Country:US
Mailing Address - Phone:540-951-1768
Mailing Address - Fax:
Practice Address - Street 1:2703 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8102
Practice Address - Country:US
Practice Address - Phone:540-951-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health