Provider Demographics
NPI:1073702130
Name:BOWERS, JASON LYNN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LYNN
Last Name:BOWERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1329
Mailing Address - Country:US
Mailing Address - Phone:573-339-1957
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4505
Practice Address - Country:US
Practice Address - Phone:573-339-1957
Practice Address - Fax:573-339-9709
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant