Provider Demographics
NPI:1013539998
Name:BOWMAN, MICAH CHRISTIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:CHRISTIAN
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 W SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1506
Mailing Address - Country:US
Mailing Address - Phone:817-809-2660
Mailing Address - Fax:
Practice Address - Street 1:2419 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1506
Practice Address - Country:US
Practice Address - Phone:469-535-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant