Provider Demographics
NPI:1194015990
Name:BOWDEN, TANYA DIAN (RD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DIAN
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SKAGGS RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2075
Mailing Address - Country:US
Mailing Address - Phone:417-334-8288
Mailing Address - Fax:417-334-6966
Practice Address - Street 1:101 SKAGGS RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2075
Practice Address - Country:US
Practice Address - Phone:417-334-8288
Practice Address - Fax:417-334-6966
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200600098278133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal