Provider Demographics
NPI:1326131814
Name:BOWEN, DANNY R (CRNA)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:R
Last Name:BOWEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WILTSHIRE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3020
Mailing Address - Country:US
Mailing Address - Phone:800-951-7850
Mailing Address - Fax:843-282-6244
Practice Address - Street 1:1230 S HURSTBOURNE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-425-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28086314367500000X
KY3001409367500000X
OHCOA.12279-NA367500000X
KY1409A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74408592Medicaid
OH0784914Medicaid
KYK105771Medicare PIN