Provider Demographics
NPI:1558936286
Name:BOWIE, PHALNESHA L (LPN)
Entity Type:Individual
Prefix:
First Name:PHALNESHA
Middle Name:L
Last Name:BOWIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5163
Mailing Address - Country:US
Mailing Address - Phone:318-787-4653
Mailing Address - Fax:
Practice Address - Street 1:4606 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3235
Practice Address - Country:US
Practice Address - Phone:418-441-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
LA230780164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician