Provider Demographics
NPI:1073083119
Name:BOWERS, MARY ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BOWERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:764 WALNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3113
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:1340 WALTER REED RD STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4451
Practice Address - Country:US
Practice Address - Phone:910-504-3506
Practice Address - Fax:910-504-3507
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily