Provider Demographics
NPI:1073630943
Name:BOWDEN, ANNA LISA (PA)
Entity Type:Individual
Prefix:
First Name:ANNA LISA
Middle Name:
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 STONE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3911
Mailing Address - Country:US
Mailing Address - Phone:559-260-3571
Mailing Address - Fax:615-277-0765
Practice Address - Street 1:4536 NOLENSVILLE PIKE STE F
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4786
Practice Address - Country:US
Practice Address - Phone:615-277-0760
Practice Address - Fax:615-277-0765
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16467363A00000X
TNPA2549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16467OtherCA PHYSICIAN ASST. LIC#
TNPA2549OtherTN LICENSE