Provider Demographics
NPI: | 1053841254 |
---|---|
Name: | BOWMAN, AMANDA SUE (FNP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | AMANDA |
Middle Name: | SUE |
Last Name: | BOWMAN |
Suffix: | |
Gender: | F |
Credentials: | FNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 420 W LONGEST ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PAOLI |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47454-8821 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-723-3944 |
Mailing Address - Fax: | 812-723-7989 |
Practice Address - Street 1: | 2516 Q ST |
Practice Address - Street 2: | |
Practice Address - City: | BEDFORD |
Practice Address - State: | IN |
Practice Address - Zip Code: | 47421-4928 |
Practice Address - Country: | US |
Practice Address - Phone: | 812-275-4228 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-06-20 |
Last Update Date: | 2023-01-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 71007172A | 363L00000X, 363LP0808X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |