Individual
BRIGETTE COWHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 N LARKIN AVE, JOLIET, IL 60435-3429
(815) 741-4300
Mailing address
800 N LARKIN AVE, JOLIET, IL 60435-3429
(815) 741-4300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007650
IL
363A00000X
Physician Assistant
2016006195
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220030033
—
MO
01
—
PENDING
RR MEDICARE
MO
05
—
PENDING
—
MO
Enumeration date
03/02/2016
Last updated
07/01/2020
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