Provider Demographics
NPI:1427218346
Name:BOWMAN, JESSICA LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEA
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-0460
Mailing Address - Country:US
Mailing Address - Phone:865-992-3867
Mailing Address - Fax:865-992-3867
Practice Address - Street 1:4335 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3623
Practice Address - Country:US
Practice Address - Phone:865-992-3867
Practice Address - Fax:865-992-7238
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00154832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse