Provider Demographics
NPI:1073244059
Name:BOWMAN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HARPER LN
Mailing Address - Street 2:
Mailing Address - City:GANDEEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25243-9287
Mailing Address - Country:US
Mailing Address - Phone:304-786-9848
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:1222 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4323
Practice Address - Country:US
Practice Address - Phone:304-865-5420
Practice Address - Fax:304-865-5423
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker