Individual provider Active NPI

Bethany Nichole Cowan, FNP-C

  • Family Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1164094744
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1044353 Issued in TX
Practice address
703 S Fleishel Ave
Tyler, TX 75701-2015
Phone
(903) 606-3000
NPI assigned
Jul 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1044353 TX Primary

Addresses

Primary practice location

703 S Fleishel Ave
Tyler, TX 75701-2015

Mailing address

1619 Stanley Dr # 100
Longview, TX 75605-4268
Phone (903) 216-7011

Other practice location 1

1783 Troup Hwy
Tyler, TX 75701-5869
Phone (903) 595-2283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210819003523 TX Practitioner - Nurse Practitioner 7810392438 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

105 Zeid Blvd
Henderson, TX 75652-6070
Phone (903) 595-2283

1302 N Pacific St
Christus Trinity Clinic
Mineola, TX 75773-1022
Phone (903) 569-5383

1783 Troup Hwy
Tyler, TX 75701-5869
Phone (903) 595-2283

18780 Interstate 20
Canton, TX 75103-3593
Phone (903) 567-4841

3201 S Loop
Palestine, TX 75801-6901

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

800 E Dawson St
Christus Trinity Clinic
Tyler, TX 75701-2036
Phone (903) 510-1186

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1044353TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Oct 11, 2021 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Oct 11, 2021 Accepting new patients

Locations

1783 Troup Hwy
Tyler, TX 75701
Phone 90359522832057

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

703 S Fleishel Ave
Ste 5000
Tyler, TX 75701
Phone (903) 525-2992

703 S Fleishel Ave
Tyler, TX 75701
Phone (903) 606-3000

Interoperability endpoints

  • Direct secure messaging: bhughes102143@christushealth.direct-ci.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1164094744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 STANLEY DR # 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756054268",
            "telephone_number": "903-216-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 S FLEISHEL AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012015",
            "telephone_number": "903-606-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1783 Troup Hwy",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757015869",
            "country_code": "US",
            "telephone_number": "903-595-2283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COWAN",
        "first_name": "BETHANY",
        "middle_name": "NICHOLE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1044353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.