Provider Demographics
NPI:1558733915
Name:BOWE, ALEXIS C
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:C
Last Name:BOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 GARDINER VIEW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1877
Mailing Address - Country:US
Mailing Address - Phone:502-456-0494
Mailing Address - Fax:502-456-0496
Practice Address - Street 1:4200 GARDINER VIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1877
Practice Address - Country:US
Practice Address - Phone:502-456-0494
Practice Address - Fax:502-456-0496
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009834363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner