Individual
STACI T COWNOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
76 CAPITAL WAY STE C, ATOKA, TN 38004-6866
(901) 840-1202
(901) 840-1204
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1191
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6007036
BCBS
TN
05
—
Q003620
—
TN
Enumeration date
07/23/2006
Last updated
05/12/2025
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