Provider Demographics
NPI:1407118722
Name:BOWEN, TAMMY JO (APRN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:BOWEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-334-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1360 DOLWICK DR
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3127
Practice Address - Country:US
Practice Address - Phone:800-737-7900
Practice Address - Fax:859-655-2320
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK084900Medicaid
OH0086522Medicaid
KY7100241310Medicaid