Provider Demographics
NPI:1033280425
Name:BOWMAN, ANGELA J (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6455
Practice Address - Country:US
Practice Address - Phone:765-453-1254
Practice Address - Fax:765-864-8732
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002212B363L00000X
IN71002212A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200842860Medicaid
INP01832344OtherRR PTAN
ININ1663093Medicare PIN
INP01832344OtherRR PTAN
IN266180778Medicare PIN