Provider Demographics
NPI:1407280449
Name:BOWLING, TIA R (NP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:R
Last Name:BOWLING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ERIE STREET
Mailing Address - Street 2:P.O. BOX 929
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331
Mailing Address - Country:US
Mailing Address - Phone:765-827-7890
Mailing Address - Fax:765-825-6628
Practice Address - Street 1:450 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3176
Practice Address - Country:US
Practice Address - Phone:765-827-7890
Practice Address - Fax:765-825-6628
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168817A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201185740Medicaid
IN231420024Medicare PIN