Provider Demographics
NPI:1972178218
Name:COWHERD, ELEANOR (APRN)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:COWHERD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:ELEANOR
Other - Middle Name:
Other - Last Name:COWHERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:124 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1100
Mailing Address - Country:US
Mailing Address - Phone:912-280-7023
Mailing Address - Fax:912-289-0909
Practice Address - Street 1:600 COASTAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1973
Practice Address - Country:US
Practice Address - Phone:912-409-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner