Provider Demographics
NPI:1508224916
Name:BOWMAN, STEPHANIE LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HEIDI WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9223
Mailing Address - Country:US
Mailing Address - Phone:304-541-8499
Mailing Address - Fax:
Practice Address - Street 1:95 HEIDI WAY
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-541-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9156432OtherMEDICARE GROUP
WV9156432OtherMEDICARE GROUP