Provider Demographics
NPI:1144225178
Name:BOWLIN, SUSAN MARY (FNP-BC, ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARY
Last Name:BOWLIN
Suffix:
Gender:F
Credentials:FNP-BC, ACNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC, ACNP-BC
Mailing Address - Street 1:2416 BELVEDERE LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-5699
Mailing Address - Country:US
Mailing Address - Phone:972-849-2190
Mailing Address - Fax:817-305-5069
Practice Address - Street 1:1600 W COLLEGE ST STE 190
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2100
Practice Address - Country:US
Practice Address - Phone:817-305-5061
Practice Address - Fax:817-305-5069
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113519363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K11JMedicare PIN
TX8L16959Medicare PIN