Provider Demographics
NPI:1174245237
Name:MCGOWAN, VICTORIA LEIGH (AGACNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEIGH
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GLAD RIK LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-1211
Mailing Address - Country:US
Mailing Address - Phone:864-923-5630
Mailing Address - Fax:
Practice Address - Street 1:222 E MEDICAL LN STE 200
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-935-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25645363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner