Provider Demographics
NPI:1558880807
Name:BOWYER, BERNADETTE LEE (PA)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:LEE
Last Name:BOWYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:LEE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3459 SAINT ROSE PKWY STE 120-461
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4601
Mailing Address - Country:US
Mailing Address - Phone:530-412-0529
Mailing Address - Fax:
Practice Address - Street 1:2720 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1575
Practice Address - Country:US
Practice Address - Phone:530-412-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558880807Medicaid