Provider Demographics
NPI:1114983665
Name:BOWERS, LEAH (FNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BOWERS
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 1:175 HECTOR AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2590
Mailing Address - Country:US
Mailing Address - Phone:504-349-6925
Mailing Address - Fax:504-362-5310
Practice Address - Street 1:175 HECTOR AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2590
Practice Address - Country:US
Practice Address - Phone:504-349-6925
Practice Address - Fax:504-362-5310
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN082724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438634Medicaid
LA4B633Medicare ID - Type Unspecified
LA1438634Medicaid